Religion and the presence and severity of depression in older adults

Burden of depression and its associated factors among older people living in Gondar town, Ethiopia: a community based cross-sectional study

OBJECTIVES

Depression is one of the main causes of disability worldwide and makes a major contribution to the global disease burden, especially in developing countries. It is also one of the most prevalent psychiatric disorders in the older people and a significant risk factor for both disability and death. Despite the fact that little research has been done on it among those who live in sub-Saharan Africa, especially Ethiopia, the aim of this study was to fill the above-mentioned gap among older people.

METHOD

A community-based cross-sectional study was conducted from April to June 2023. A total of 607 older people were included using the multistage sampling technique. An interview-administered questionnaire was used to assess depression using the Geriatric Depression Scale item 15 with a cut-off ≥5. For statistical analysis, the binary logistic regression model was employed.

RESULTS

The mean age of the study participants was 72.45 (SD ±9.08) years. The prevalence of depression was found to be 45%. Age 80 years and above, 70-79 years, widowed, retired, known chronic disease, and poor social support were associated factors with depression.

CONCLUSION

Compared to other studies conducted in different regions of Ethiopia, the prevalence of depression in this study was found to be high, at 45%. The results of this study may be taken as providing health professionals, health policymakers, and other pertinent stakeholders' early warning signs and guidance on how to take efficient control measures and conduct periodic monitoring among older people.

The relationship between marital status and cognitive impairment in Chinese older adults: the multiple mediating effects of social support and depression

BACKGROUND

Marital status is a potentially essential factor for cognitive impairment. Relevant research examining the potential pathways through which the marital status of spouseless older people is associated with cognitive impairment needs to be more adequate. Therefore, this study aims to investigate the serial mediating effects of various forms of social support and depression between marital status and cognitive impairment in older Chinese people.

METHODS

This study involved a secondary analysis of data from the 2014-2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with a total of 2,647 Chinese older adults and 53.6% being males. Mediation analysis using the SPSS process macro was conducted.

RESULTS

The results indicated that marital status was significantly predictive of cognitive impairment among older people, and those with a spouse exhibited higher cognitive functioning. Informal social support and depression were found to play partial mediating roles in the association between marital status and cognitive impairment. The findings also revealed that marital status was unrelated to formal social support, and no association between formal social support and cognitive impairment was found.

CONCLUSIONS

The study findings highlight the need for social service providers to design programs for promoting connections associated with informal support to reduce their risk of depression and cognitive impairment and for policymakers to develop effective formal social support systems for older people without spouses. This study indicated that older people could regain the benefits of marriage to lower the risk of depression and improve their mental health.

"We Never Stop Singing": The Dynamics of the Mental and Physical Health of Czech Religious Pastors during the COVID-19 Pandemic

This study explores the dynamics of coping strategies of Czech religious leaders during a peak of the COVID-19 pandemic. An interpretative phenomenological analysis reveals that mental health among pastors is closely linked to a need to maintain community and social contact, while physical health is related to limitations upon ritual elements. In all narratives, the lived experience of mental health in the form of prosocial behavior is significantly prioritized despite the possibility of spreading infection. The analysis also shows that maintaining the community is closely linked to risky behaviors, which positively affected group and individual well-being.

Religiosity and Depression Among Community-Dwelling Older Adults in India: Results of a National Survey in 2017-2018

This study aimed to investigate the association between religiousness (affiliation, nonorganizational, organizational, and intrinsic religiosity) and major depressive disorder (MDD) and depressive symptoms among older adults in a national population survey in India. In total, 72,262 people (≥ 45 years) from the cross-sectional longitudinal aging study in India 2017-2018 responded to questions on religiosity, MDD, and depressive symptoms. Results indicate that 57.0% of participants were engaged in high nonorganizational (daily prayer) religiosity, 14.0% engaged in high (> 1/week or every day) organizational religiosity (attending religious services) and 34.9% had high intrinsic religiosity. In the adjusted logistic regression analysis, high nonorganizational religiosity (daily prayer), and high intrinsic religiosity were inversely associated with MDD. Similarly, high nonorganizational religiosity and high intrinsic religiosity were inversely associated with depressive symptoms. Organizational religiosity was not significantly associated with MDD or depressive symptoms. Compared to Hindus, Christians had lower odds of MDD and Sikhs had lower odds of depressive symptoms. High religiosity was observed among older adults in India. Nonorganizational and intrinsic religiosity were inversely associated with MDD and depressive symptoms.

Questionnaire-free machine-learning method to predict depressive symptoms among community-dwelling older adults

The 15-item Geriatric Depression Scale (GDS-15) is widely used to screen for depressive symptoms among older populations. This study aimed to develop and validate a questionnaire-free, machine-learning model as an alternative triage test for the GDS-15 among community-dwelling older adults. The best models were the random forest (RF) and deep-insight visible neural network by internal validation, but both performances were undifferentiated by external validation. The AUROC of the RF model was 0.619 (95% CI 0.610 to 0.627) for the external validation set with a non-local ethnic group. Our triage test can allow healthcare professionals to preliminarily screen for depressive symptoms in older adults without using a questionnaire. If the model shows positive results, then the GDS-15 can be used for follow-up measures. This preliminary screening will save a lot of time and energy for healthcare providers and older adults, especially those persons who are illiterate.

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.

An Analysis of the Relationship Between Religiosity and Psychological Well-Being in Chilean Older People Using Structural Equation Modeling

Using a representative sample, we explored the relationship of organizational (ORA), non-organizational (NORA), and intrinsic religiosity (IR) with depressive and anxious symptomatology and loneliness in Chilean older people, and examined mediating mechanisms. Structural Equation Modeling showed a direct effect between ORA and reduced depressive symptomatology and between IR and anxious symptomatology; for indirect effects, the relationship between ORA and depressive and anxious symptomatology was mediated by friends' social support network, while that between IR and the three outcomes studied was mediated by the family support network and resilience. NORA was not associated with any of the outcomes or mediating variables.

Religion and mental health among older adults: ethnic differences in Malaysia

OBJECTIVES

Religion and spirituality gain importance as a person ages. Research has shown that religion has a salutary effect on mental health, and it is associated with health differently across ethnic groups. The current study examined ethnic differences in the association between religion and mental health among older adults in a predominantly Muslim population and multicultural setting.

METHODS

Data of 7068 participants (4418 Malays, 2080 Chinese and 570 Indians) aged ≥55 years that were collected as part of the community health survey conducted in 2013 in the South East Asia Community Observatory (SEACO) were analyzed using bivariate and multiple regressions. Analyses were stratified by ethnicity.

RESULTS

The importance of having an enriched religious/spiritual life was associated with higher scores of depression, anxiety and stress among Chinese and higher score of depression among Malays, while belief in a higher power was associated with better mental health among Malays, Chinese and Indians.

CONCLUSION

The current study showed that there were ethnic variations in the associations between religion and mental health, and the associations depended on the religious variable included in the analysis. The findings of this study showed that religion could be another potential channel to improve mental health among older adults by accommodating and understanding their religious beliefs.

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.

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.

Religion/Spirituality and Gender-Differentiated Trajectories of Depressive Symptoms Age 13-34

Studies examining religion/spirituality (R/S) and depressive symptoms report divergent findings, often depending on the types of variables considered. This study assessed whether subjective and experiential R/S variables were associated with increased depressive symptom burden from adolescence to young adulthood. Variations by gender were also assessed. Using group-based trajectory modeling with a cohort-sequential design, four distinct symptom trajectories were identified for women and five for men. 27.4% of women and 10.2% of men were classified on peak trajectory groups. Religious attendance was protective for men and women. Prayer was protective for women but linked to risk for men. Born-again and life-changing spiritual experiences, along with belief in supernatural leading and angelic protection, were broadly associated with increased classification on elevated symptom trajectories. In one exception, belief in supernatural leading was associated among some men with decreased risk of depressive symptoms during adolescence. Researchers must take a variety of R/S variables into account when assessing depressive symptoms, not simply religious attendance, prayer frequency, or affiliation as is commonly practiced. Religion and spirituality are multidimensional and in some cases may operate differently for men than women vis-à-vis mental well-being.

Religious Attendance, Religious Importance, and the Pathways to Depressive Symptoms in Men and Women Aged 50 and Over Living in Ireland

OBJECTIVES

We aimed to explore the relationship between religiosity and depressive symptoms longitudinally.

METHOD

We used four waves (2009-2016) of the Irish Longitudinal Study on Ageing (TILDA) to create growth curve models (GCM) of depressive symptoms and religious attendance/importance in a sample aged 50+ in Ireland and structural models to assess the longitudinal associations between religious attendance/importance and depressive symptoms. We tested whether this relationship was mediated by social connectedness.

RESULTS

GCM showed that higher religious attendance at baseline was associated with lower baseline depressive symptoms, while higher religious importance was associated with higher baseline depressive symptoms. Social connectedness partially mediated the baseline associations between religious attendance and lower depressive symptoms. There were no associations between religious factors and the development of depressive symptoms over time.

DISCUSSION

This study found that the relationship between religion and depressive symptoms is complex, and any protective effect was driven by religious attendance.

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.

Religiosity and self-rated health among older adults in Colombia

Objective:

To identify the relationship between religiosity and self-rated health 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 18,871 community-dwelling adults aged 60 years and older living in urban and rural areas of Colombia. Religiosity was assessed by self-rated religiosity (how religious are you: not at all, somewhat or very). Self-rated health during previous 30 days was assessed as very good, good, fair, poor or very poor, analyzed as an ordinal variable (1-5) using weighted logistic regression, adjusting for confounders.

Results:

Those who were more religious were older, female, had lower socioeconomic status, and were more likely to be married. Multivariate analyses demonstrated that older adults who were more religious had better self-rated health (OR 0.92 95% CI 0.86-0.99, p= 0.038); however, there was a significant interaction effect between gender and religiosity on self-rated health (p= 0.002), such that the relationship between religiosity and health was stronger in men (OR 0.86, 95% CI: 0.79-0.94, p= 0.001) but not significant in women.

Conclusion:

Older adults in Colombia who consider themselves more religious, especially men, are less likely to perceive their physical health as poor compared to those who are less religious.

Religious affiliation and major depressive episode in older adults: a cross-sectional study in six low- and middle- income countries

Background

The relationship of religious affiliation and mental health is complex, and being part of a minority religious group could have negative effects on mental health. In this study, we assessed the association between religious affiliation and major depressive episode (MDE) in older adults (> = 60 years) from China, Ghana, India, Mexico, Russia and South Africa.

Methods

We conducted a secondary analysis of data from the Study on global Ageing and adult health (SAGE), with six nationally-representative community-based samples (n = 21,410). Religious affiliation was self-reported by participants, and we defined MDE based on ICD-10 classification. We estimated the association of MDE with religious affiliation versus no religious affiliation, and minority versus majority affiliation.

Results

We observed no association between having a religious affiliation (vs. no affiliation) and the odds of MDE in older adults. In most cases minorities had higher odds of MDE as compared with the majority religion, but the associations were only significant for Muslims in Ghana and for Muslims, Hindus and Other in South Africa.

Conclusions

While the results were significant only for two countries, we observed higher odds of MDE among minorities in most of them. Older adults who are members of religious minorities might be at risk for mental health problems, and there is a need for public health interventions aimed at them.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6806-1) contains supplementary material, which is available to authorized users.

Does Religion Predict Health-Promoting Behaviors in Community-Dwelling Elderly People?

As the aging phenomenon gains importance in many societies, regular health-promoting activities by the elderlies become more crucial for disability reduction and their health promotion. Religious viewpoints and perspectives can have an influence on the individuals' assessment of life events. Recent studies show a correlation between religiosity and mental health. However, there is limited number of studies on the relationship between religiosity and health behaviors, especially in elderly. The purpose of this research is to evaluate religion's predictive power in health-improving behaviors of the elderly. This cross-sectional study was conducted on 316 community-dwelling elderly with the mean age of 67.9 ± 6.6 years, who were functionally independent without cognitive or mental impairments. Health-promoting lifestyle profile 2 assessment (HPLP2) and Alport questionnaires were used to assess health behaviors and religious orientation, respectively. Data analysis was performed by independent T test and multiple linear regression models with SPSS version 23. An internal religious orientation was found in 71 elderly; this accounts for 22.5% of the study population. Based on the health behavior scoring 154 individuals, 48.8% of the study population obtained a score of higher or equal to 139. These individuals were placed on third quartile and higher. Among the health behavior components, "the health responsibility" was the only component related to religious orientation [internal 25.1 ± 6.6 (P < 0.001, r = 0.78) vs. external 22.6 ± 6.5 (P > 0.05, r = 0.22)]. Based on the multiple linear regression models, no significant relationship was found between total health behavior score and religious orientation. However, a significant relationship existed between the participants' health behaviors and some of their profile. The results indicate that despite good health behaviors in nearly half of the elderlies, no significant relationship was found between health behavior and religious orientation. The results suggest possible impact of other religion-related concepts including private religious behaviors, devotion, spiritual transcendence, religious adaptation, and religious traditions and experiences on the health behaviors. These concepts require further study for better understanding of their impact.

Enhancing Meaning when Facing Later Life Losses

OBJECTIVE

This article presents several client cases to illustrate psychotherapeutic interventions for helping older adults facing later life losses enhance their sense of meaning.

METHODS

Cases are derived from the client population of a community mental health clinic which provides psychotherapy for low income, seriously mentally ill, culturally diverse older adults, many of whom experience serious medical illnesses. Over the course of 24 years in this setting, the primary author has observed various interventions which offer possibilities to provide hope and meaning for clients with severe problems.

RESULTS

Interventions discussed with individual cases include utilizing life review and reminiscence therapies, helping in grappling with the ending of life, facilitating enhanced relationships, encouraging creative endeavors, enabling spiritual and religious practices, honoring wisdom and legacy leaving, and engaging in mindfulness practices. Each approach is reviewed with reference to empirical support, clinical utility, and treatment considerations.

CONCLUSIONS

Helping older adults to find hope and meaning in their lives can be challenging. Specific interventions which target meaning-making may be adapted to fit each client's needs.

CLINICAL IMPLICATIONS

Clinicians may focus on enhancing meaning as a core or adjunct aspect of treatment with older adult clients. Considerations for implementing interventions may depend on contextual factors relevant to each case.

Religiousness, social support and the use of antidepressants among the elderly: a population-based study

The purpose of the study was to investigate whether religiousness and social support were associated with the use of antidepressants among community-dwelling elders. The research involved 1,606 older adults who make up the cohort of Bambuí Project, a study on ageing and health. The dependent variable was the use of antidepressants in the last 90 days, and the exposures of interest were social support and religiousness. Logistic regression was used to test the associations and to estimate crude and adjusted Odds Ratio and their 95% confidence intervals. The chances of use of antidepressants were significantly lower among older people with higher level of religiosity (OR = 0.45; 95% CI: 0.29 to 0.70), but none of the descriptors social support was associated with the event. In this population, it is possible that religion occupies a prominent role in the arsenal of health problems coping strategies, especially mental. Health professionals attending this particular segment of the population (elderly people with depressive disorders) should consider religiousness of patients when the proposed guidelines and treatment in coping with their mental suffering.

Depression and its associated factors among elderly: A community-based study in Egypt

BACKGROUND

Depression among the elderly constitutes a major public health concern that attracts worldwide attention. The aim of this study is to estimate the prevalence of depression and its associated factors among community dwelling elderly.

METHODS

A cross-sectional descriptive study with an analytic component was carried out in both urban and rural areas of Mansoura District during the period from October 1 to December 31, 2016. The target population is elderly aged 60 years or more of both genders. A total sample of 487 elderly was selected by systematic random sample from family files kept at Family Health Units. The response rate was 97.9%.

RESULTS

The overall prevalence of depression was 44.4%. Urban residence, insomnia, being a woman, life stressors, disturbed marital life, dependent old adults and absence of religiosity are the main independent predictors of depression among elder people.

CONCLUSIONS

This study provide an alarming signal for health professionals and health policy maker in Egypt for the need of a better recognition of depressive symptoms in elderly.

Social capital, socioeconomic status, and depression in community-living elderly

A growing body of evidence has suggested that social capital is an upstream social determinant of mental health. We investigated the association of cognitive social capital, including interpersonal trust and reciprocity, with depressive symptoms in the elderly. We also explored the mediating role of cognitive social capital in the association between socioeconomic status (SES) and depressive symptoms and the moderating effect of SES on the relationship between social capital and depressive symptoms. Data from the 2012 Korea Welfare Panel Study (KOWEPS) was analyzed for 5969 participants aged 60 years or older. Cognitive components of social capital, including interpersonal trust and reciprocity, were evaluated using single-item questionnaires. Socioeconomic and health-related characteristics were investigated and depressive symptoms were evaluated by an 11-item version of the Center for Epidemiologic Studies Depression Scale. Low interpersonal trust and reciprocity levels were significantly associated with depressive symptoms in the elderly. Reciprocity level mediated the association between household income level and depressive symptoms. We did not observe any significant moderating effect of SES on the association between cognitive social capital and depressive symptoms. A significant association between cognitive social capital and depressive symptoms in Korean elderly was found. We elucidated how SES interacted with depressive symptoms through the mediation pathway of cognitive social capital using a representative sample of the Korean elderly population.

Effect of Religiosity on Voice

The aim of this study was to examine the relationship between religiosity and phonatory behavior. A total of 186 participants participated in a survey that included four sections: demographic data, extent of religiosity, history of dysphonia, phonatory behavior and laryngeal manipulation, in addition to the Voice Handicap Index (VHI-10). There was no significant association between the prevalence of phonatory symptoms and any of the religiosity questions. There was no significant association between phonatory behavior, history of laryngeal manipulation and any of the religiosity questions. There was also no significant association between the score of the Voice Handicap Index and any of the five religiosity questions. There is no association between religiosity and prevalence of phonatory disturbances, phonotraumatic behavior and/or history of laryngeal manipulation.

Processes Linking Religious Involvement and Telomere Length

Although numerous studies suggest that religious involvement is associated with better health and longer life expectancies, it is unclear whether these general patterns extend to cellular aging. The mechanisms linking indicators of religious involvement with indicators of cellular aging are also undefined. We employed longitudinal data from the 2004 and 2008 Health and Retirement Study, a national probability sample of Americans aged 50 and older, to test whether average telomere length varied according to level of religious attendance. We also tested several potential mechanisms. Our results showed that respondents who attended religious services more frequently in 2004 also exhibited fewer stressful events, lower rates of smoking, fewer symptoms of depression, and lower levels of C-reactive protein in 2008. Respondents who increased their level of attendance from 2004 to 2008 also exhibited lower rates of smoking in 2008. Although religious attendance was not directly associated with telomere length, our mediation analyses revealed significant indirect effects through depression and smoking, but not stressful events or C-reactive protein. We conclude that religious attendance may promote telomere length indirectly by reducing symptoms of depression and the risk of smoking. There was no evidence to support stressful events or C-reactive protein as mechanisms of religious attendance.

Forms of Attrition in a Longitudinal Study of Religion and Health in Older Adults and Implications for Sample Bias

The use of longitudinal designs in the field of religion and health makes it important to understand how attrition bias may affect findings in this area. This study examines attrition in a 4-wave, 8-year study of older adults. Attrition resulted in a sample biased toward more educated and more religiously involved individuals. Conditional linear growth curve models found that trajectories of change for some variables differed among attrition categories. Ineligibles had worsening depression, declining control, and declining attendance. Mortality was associated with worsening religious coping styles. Refusers experienced worsening depression. Nevertheless, there was no evidence of bias in the key religion and health results.

Participation in Physical, Social, and Religious Activity and Risk of Depression in the Elderly: A Community-Based Three-Year Longitudinal Study in Korea

BACKGROUND

We examined the longitudinal association between participation in individual or combinations of physical, social, and religious activity and risk of depression in the elderly.

METHODS

Elderly subjects aged ≥ 60 years who completed the Living Profiles of Older People Survey in Korea (n = 6,647) were included. The baseline assessment, Wave 1, was conducted in 2008, and a follow-up assessment, Wave 2, was conducted in 2011. We defined participation in frequent physical activity as ≥ 3 times weekly (at least 30 minutes per activity). Frequent participation in social and religious activity was defined as ≥ 1 activity weekly. The primary outcome was depression at 3-year follow up.

RESULTS

Multivariable logistic regression analysis showed that subjects who participated in frequent physical, social, and religious activity had an adjusted odds ratio of 0.81 (95% confidence interval [CI], 0.69-0.96), 0.87 (95% CI, 0.75-1.00), and 0.78 (95% CI, 0.67-0.90), respectively, compared with participants who did not participate in each activity. Participants who participated in only one type of activity frequently and participants who participated in two or three types of activities frequently had an adjusted odds ratio of 0.86 (95% CI, 0.75-0.98) and 0.64 (95% CI, 0.52-0.79), respectively, compared with participants who did not participate in any type of physical, social, and religious activity frequently.

CONCLUSION

Participation in physical, social, and religious activity was associated with decreased risk of depression in the elderly. In addition, risk of depression was much lower in the elderly people who participated in two or three of the above-mentioned types of activity than that in the elderly who did not.

A change in social activity and depression among Koreans aged 45 years and more: analysis of the Korean Longitudinal Study of Aging (2006-2010)

BACKGROUND

The aim of this study is to examine a relationship between a change in social activity and depression among Koreans aged 45 years or more.

METHODS

Data came from the Korean Longitudinal Study of Aging (KLoSA) (2006-2010), with 5,327 participants aged 45 years or more. The generalized estimating equation (GEE) with the logit link was used to investigate an association between a change in social activity during 2006-2008 (or 2008-2010) and depression among respondents in year 2008 (or Y2010). Depression was measured by Center for Epidemiological Studies Depression scale (CES-D10) and a change in social activity was classified with four categories, i.e. "consistent participation", "consistent non-participation", "participation to non-participation", and "non-participation to participation". Social activity was divided into various elements and the same analysis was conducted for each of these elements.

RESULTS

Those with consistent non-participation and from participation to non-participation were more likely to be depressed than those with consistent participation and from non-participation to participation in social activities (OR 1.44 [95% CI 1.22-1.71], OR 1.35 [95% CI 1.15-1.58] vs. OR 1.00 [Reference], OR 1.27 [95% CI 1.09-1.48]). In addition, the strength of the negative association between consistent or new participation in social activity and depression was different across different elements of social activity. The negative association was particularly strong for leisure, culture or sports clubs, and for family or school reunion.

CONCLUSION

For improving the mental health of the population aged 45 years or more, the promotion of their continued or new participations in leisure/culture clubs and family/school reunion might be needed in South Korea.

Psychiatrists' and primary care physicians' beliefs about overtreatment of depression and anxiety

Critics say that physicians overdiagnose and overtreat depression and anxiety. We surveyed 1504 primary care physicians (PCPs) and 512 psychiatrists, measuring beliefs about overtreatment of depression and anxiety and predictions of whether persons would benefit from taking medication, investing in relationships, and investing in spiritual life. A total of 63% of PCPs and 64% of psychiatrists responded. Most agreed that physicians too often treat normal sadness as a medical illness (67% of PCPs and 62% of psychiatrists) and too often treat normal worry and stress as a medical illness (59% of PCPs, 55% of psychiatrists). Physicians who agreed were less likely to believe that depressed or anxious people would benefit "a lot" from taking an antidepressant (36% vs. 58% of PCPs) or antianxiety medication (25% vs. 42% of PCPs, 42% vs. 57% of psychiatrists). Most PCPs and psychiatrists believe that physicians too often treat normal sadness and worry as a medical illness.

Twelve-year history of late-life depression and subsequent feelings to God

OBJECTIVES

Growing evidence shows several possible relations between religiousness and late-life depression. Emotional aspects of religiousness such as facets of the perceived relationship with God can be crucial in this connection. The aim of the current study was to examine the association between the course of late-life depression and feelings about God and religious coping.

DESIGN

Longitudinal survey study; naturalistic; 12-year follow-up.

SETTING

Longitudinal Aging Study Amsterdam; population-based, in three regions in The Netherlands.

PARTICIPANTS

A subsample of 343 respondents (mean age: 77.2 years), including all respondents with high levels of depressive symptoms at any measurement cycle between 1992 and 2003 (assessed by using the Center for Epidemiologic Studies Depression Scale and the Diagnostic Interview Schedule) and a random sample of nondepressed respondents who completed a postal questionnaire in 2005.

MEASUREMENTS

Scales on God Image and Religious Coping. Twelve-year depression course trajectories serve as predicting variables and are specified according to recency and seriousness.

RESULTS

Persistent and emergent depression are significantly associated with fear of God, feeling wronged by God, and negative religious coping. In terms of negative religious coping, significant associations were observed after adjustment for concurrent depression with a history of repeated minor depression and previous major depression.

CONCLUSIONS

Late-life depression seems to maintain a pervasive relationship over time with affective aspects of religiousness. Religious feelings may parallel the symptoms of anhedonia or a dysphoric mood and could represent the experience of an existential void.

Religiosity After a Diagnosis of Cancer Among Older Adults

Aspects of religiosity are important to health and quality of life of cancer patients. This analysis examined changes in religiosity among community-dwelling cancer survivors. Previously diagnosed and newly diagnosed cancer survivors age 65+ were interviewed at baseline and four years later to understand how components of religiosity may change. Religiosity was assessed as organizational, non-organizational, and intrinsic using the Duke Religiosity Scale. At four years, 45 persons had a new diagnosis of non-skin cancer in addition to the 94 diagnosed at baseline. In comparison to persons without a cancer diagnosis and participants with a baseline diagnosis, newly diagnosed participants were more likely to decrease church attendance. Although not statistically significant, a larger proportion of recently diagnosed persons increased non-organizational religiosity behaviors and intrinsic religiosity compared to those with cancer at baseline and those without cancer. African Americans were more likely than Caucasians to show increased non-organizational religiosity. Caucasians with a cancer diagnosis showed increased intrinsic religiosity, perhaps because of a ceiling effect among African Americans. Although all groups showed declines and increases in the measures, baseline religiosity was the strongest predictor of religiosity at 48 months, indicating stability in religiosity over time, even in the context of a cancer diagnosis.

Typology of religiosity/spirituality in relation to perceived health, depression, and life satisfaction among older Korean immigrants

OBJECTIVES

The objectives of this study were (1) to identify distinct subtypes of older Korean immigrants based on their levels of religiosity/spirituality (R/S) and (2) to determine if the identified subtypes differed by demographic characteristics, perceived health, depression, and life satisfaction.

METHOD

Factor mixture models were evaluated with a nonprobability sample of older Korean immigrants (N=200) residing in the New York City area in 2009 to classify typologies of R/S. Multiple regression was used to test the associations between the R/S subtypes and outcomes (perceived health, depression, and life satisfaction) while controlling for demographics.

RESULTS

Two substantively distinct latent profiles were identified: normally religious/spiritual ('average R/S') and minimally religious/spiritual ('low R/S'). The average R/S subgroup (74.4%) showed higher means than those in the low R/S subgroup (25.6%) on all six R/S class indicators. Subtypes did not differ on age, education, income, marital status, living arrangements, or years in the USA. However, males were more likely than females to be 'average R/S.' The 'average R/S' subtype had significantly greater life satisfaction than their 'low R/S' counterpart. No differences between the two subtypes were found on perceived health or depression.

CONCLUSION

Findings highlight the importance of the classifications of R/S for mental health outcomes, and they indicate that relationships among R/S, various demographic characteristics, and physical/mental health are complex. Future research should validate and refine this classification of R/S in order to help identify particular sources of health risks/behaviors, relevant treatments, and health-promoting interventions within homogenous subtypes of older Korean immigrants.

Religious attendance after elevated depressive symptoms: is selection bias at work?

In an attempt to determine if selection bias could be a reason that religious attendance and depression are related, the predictive value of elevated depressive symptoms for a decrease in future attendance at religious services was examined in a longitudinal panel of 1,673 Dutch adults. Religious attendance was assessed yearly over five years using the single question, “how often do you attend religious gatherings nowadays?” Depressive symptoms were assessed four times within the first year using the Depression subscale of the Brief Symptom Inventory. Logistic regression models of change in attendance were created, stratifying by baseline attendance status. Attenders who developed elevated symptoms were less likely to subsequently decrease their attendance (relative risk ratio: 0.55, 95% CI [0.38–0.79]) relative to baseline as compared to those without elevated symptoms. This inverse association remained significant after controlling for health and demographic covariates, and when using multiply imputed data to account for attrition. Non-attenders were unlikely to start attending after elevated depressive symptoms. This study provides counter evidence against previous findings that church attenders are a self-selected healthier group.

Religiosity and Function Among Community-Dwelling Older Adult Survivors of Cancer

Aspects of religiosity/spirituality are important to health and quality of life of cancer patients. The three components of religiosity of the Duke Religiosity Scale: organizational (religious affiliation and attendance); non-organizational (prayer, meditation, and private study); and intrinsic religiosity (identification with a higher power and integration of spiritual belief into daily life) are used to determine whether religiosity was associated with physical and/or mental functioning among older cancer survivors of the UAB Study of Aging. Church attendance was independently associated with lower ADL and IADL difficulty and fewer depressive symptoms, while intrinsic religiosity was independently associated with lower depression scores.

Religious attendance, spirituality, and major depression in Canada: a 14-year follow-up study

OBJECTIVE

Although there have been numerous studies on the relation of religion or spirituality and major depression, few used a longitudinal, nationally representative sample. Our study sought to examine the effect of religious attendance, self-declared importance of spiritual values, and self-identification as a spiritual person on major depression.

METHOD

Data coming from 8 waves (1994 to 2008) of the longitudinal Canadian National Population Health Survey were used. People (n = 12 583) who were not depressed at baseline (1994) were followed during 14 years. Depression at each cycle was assessed using the Composite International Interview-Short Form for Major Depression. Weibull proportional hazards regression was used to model longitudinal risk of depression, with religious attendance or spirituality as a predictor.

RESULTS

At baseline, monthly religious attenders tended to be older, female, and married, compared with occasional and nonattenders. The Weibull regression model revealed a 22% lower risk of depression for monthly attenders (hazard ratio 0.78, 95% CI 0.63 to 0.95), compared with nonattenders, after controlling for age, household income, family and personal history of depression, marital status, education, and perceived social support. Neither self-reported importance of spiritual values nor identification as a spiritual person was related to major depressive episodes.

CONCLUSION

Attending religious services at least monthly has a protective effect against major depression.

Religious attendance and social adjustment as protective against depression: a 10-year prospective study

BACKGROUND

Previous research has identified elevated social adjustment and frequent religious attendance as protective against depression. The present study aims to examine the association of frequency of religious services attendance with subsequent depression, while accounting for the effects of social adjustment.

METHOD

Participants were 173 adult offspring of depressed and nondepressed parents, followed longitudinally over 25 years. Diagnosis was assessed with the Schedule for Affective Disorders and Schizophrenia-Lifetime Version. The Social Adjustment Scale-Self Report (SAS-SR) was used to assess social adjustment and frequency of religious services attendance was self-reported. In a logistic regression analysis, major depression at 20 years was used as the outcome measure and the frequency of religious services attendance and social adjustment variables at 10 years as predictors.

RESULTS

Frequent religious services attendance was found to protect against subsequent depression at a trend level. High functioning social adjustment was found to protect against subsequent depression, especially within the immediate and extended family. Adults without a depressed parent who reported attending religious services atleast once a month had a lower likelihood of subsequent depression. Among adults with a depressed parent, those with high functioning social adjustment had a lower likelihood of subsequent depression.

LIMITATIONS

Measurement of social adjustment was non-specific to religious services.

CONCLUSIONS

Frequent religious attendance may protect against major depression, independent from the effects of social adjustment. This protective quality may be attenuated in adults with a depressed parent. High functioning social adjustment may be protective only among offspring of depressed parents.