Clarifying the relationship between religiosity and psychiatric illness: the impact of covariates and the specificity of buffering effects

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 Dynamic Universal Profiles of Spiritual Awareness: A Latent Profile Analysis

The aim of the current investigation was to identify universal profiles of lived spirituality. A study on a large sample of participants (N = 5512) across three countries, India, China, and the United States, suggested there are at least five cross-cultural phenotypic dimensions of personal spiritual capacity—spiritual reflection and commitment; contemplative practice; perception of interconnectedness; perception of love; and practice of altruism—that are protective against pathology in a community sample and have been replicated in matched clinical and non-clinical samples. Based on the highest frequency combinations of these five capacities in the same sample, we explored potentially dynamic profiles of spiritual engagement. We inductively derived five profiles using Latent Profile Analysis (LPA): non-seeking; socially disconnected; spiritual emergence; virtuous humanist; and spiritually integrated. We also examined, in this cross-sectional data, covariates external to the LPA model which measure disposition towards meaning across two dimensions: seeking and fulfillment, of which the former necessarily precedes the latter. These meaning covariates, in conjunction with cross-profile age differences, suggest the profiles might represent sequential phases along an emergent path of spiritual development. Subsequent regression analyses conducted to predict depression, anxiety, substance-related disorders, and positive psychology based on spiritual engagement profiles revealed the spiritually integrated profile was most protected against psychopathology, while the spiritual emergence profile was at highest risk. While this developmental process may be riddled with struggle, as evidenced by elevated rates of psychopathology and substance use in the intermediate phases, this period is a transient one that necessarily precedes one of mental wellness and resilience—the spiritual development process is ultimately buoyant and protective.

Phenotypic Dimensions of Spirituality: Implications for Mental Health in China, India, and the United States

While the field of empirical study on religion and spirituality in relation to mental health has rapidly expanded over the past decade, little is known about underlying dimensions of spirituality cross-culturally conceived. We aimed to bridge this gap by inductively deriving potential universal dimensions of spirituality through a large-scale, multi-national data collection, and examining the relationships of these dimensions with common psychiatric conditions. Five-thousand five-hundred and twelve participants from China, India, and the United States completed a two-hour online survey consisting of wide-ranging measures of the lived experience of spirituality, as well as clinical assessments. A series of inductive Exploratory Factor Analysis (EFA) and cross-validating Exploratory Structural Equation Modeling (ESEM) were conducted to derive common underlying dimensions of spirituality. Logistic regression analyses were then conducted with each dimension to predict depression, suicidal ideation, generalized anxiety, and substance-related disorders. Preliminary EFA results were consistently supported by ESEM findings. Analyses of 40 spirituality measures revealed five invariant factors across countries which were interpreted as five dimensions of universal spiritual experience, specifically: love, in the fabric of relationships and as a sacred reality; unifying interconnectedness, as a sense of energetic oneness with other beings in the universe; altruism, as a commitment beyond the self with care and service; contemplative practice, such as meditation, prayer, yoga, or qigong; and religious and spiritual reflection and commitment, as a life well-examined. Love, interconnectedness, and altruism were associated with less risk of psychopathology for all countries. Religious and spiritual reflection and commitment and contemplative practice were associated with less risk in India and the United States but associated with greater risk in China. Education was directly associated with dimensions of spiritual awareness in India and China but inversely associated with dimensions in the United States. Findings support the notion that spirituality is a universal phenomenon with potentially universal dimensions. These aspects of spirituality may each offer protective effects against psychiatric symptoms and disorders and suggest new directions for treatment.

Differences between White and Black young women in the relationship between religious service attendance and alcohol involvement

BACKGROUND AND OBJECTIVES

We examined the associations of religious attendance during childhood (C-RA) and adulthood (A-RA) with alcohol involvement (ever drinking, timing of first alcohol use, and alcohol use disorder [AUD]) in White and Black female twins. As genetic and environmental factors influence religious attendance and alcohol involvement, we examined the extent to which they contribute to their association.

METHODS

Data on 3,234 White and 553 Black female twins (18-29 years) from the Missouri Adolescent Female twin Study. Significant correlations between C-RA or A-RA and alcohol involvement were parsed into their additive genetic, shared environmental, and individual-specific environmental sources.

RESULTS

C-RA was associated with ever drinking and timing of first alcohol use in Whites. A-RA was associated with ever drinking and AUD in both Whites and Blacks. Shared environmental influences did not contribute to alcohol or religiosity phenotypes in Blacks. In Whites, the association between C-RA and alcohol was due to shared environmental influences, whereas the association between A-RA and alcohol was attributable to additive genetic, shared environmental, and individual-specific environmental sources. Individual-specific environment and genetics contributed to associations between A-RA and ever drinking and AUD, respectively, in Blacks.

CONCLUSIONS

Factors other than C-RA contribute to lower rates of alcohol involvement in Blacks. Shared environment does not contribute to links between A-RA and alcohol involvement in Blacks.

SCIENTIFIC SIGNIFICANCE

The protective impact of childhood religiosity on alcohol use and misuse is important in Whites and is due to familial factors shared by religiosity and alcohol involvement. (Am J Addict 2017;26:437-445).

Religion as Moderator of the Depression-Health Connection

This study used a representative community-based sample of men and women born in the San Francisco Bay Area in the 1920s to investigate the long-term relations between religiousness, spirituality, depression, and physical health. In late adulthood (age late 60s/mid-70s), religiousness buffered against depression associated with poor physical health, with highest levels of depression observed in the low-religiousness-poor-physical-health group. The buffering effect of religiousness was present after controlling for social support and was predicted longitudinally using religiousness scored in middle adulthood (age 40s)—a time interval of approximately 30 years. Spirituality, operationalized in terms of adherence to noninstitutionalized religious beliefs and practices, did not have the same buffering effect as religiousness. The findings are discussed with regard to the mechanisms underlying the salutary effect of religion on depression resulting from personal adversity.

Religiosity and longitudinal change in psychosocial functioning in adult offspring of depressed parents at high risk for major depression

BACKGROUND

Recent findings suggest that beliefs about religious or spiritual importance or attending religious/spiritual services may protect high-risk offspring against depression. This research has not extended to examining religiosity in relation to psychosocial functioning in high-risk offspring.

METHODS

Offspring selected for having a depressed parent and offspring of nondepressed parents were evaluated for lifetime major depressive disorder (MDD) in childhood and adolescence, and at 10-year (T10) and 20-year (T20) follow-ups. Relations between self-reported religiosity at T10 and longitudinal change in psychosocial function from T10 to T20 (assessed by clinical ratings on Global Assessment Scale [GAS]) were examined separately in 109 daughters and 76 sons by risk status.

RESULTS

Lifetime MDD was diagnosed in 57.8% of daughters and 40.8% of sons by T20. Among daughters, only those with lifetime MDD showed improved psychosocial functioning in relation to higher level of service attendance at T10, their mean GAS score improving by 3.5 points (P = .018) over the next decade. For daughters with and without lifetime MDD, relations between higher levels of religiosity and improved psychosocial function were of greater magnitude in those with a depressed parent. Among sons, only those with lifetime MDD showed improved psychosocial function in relation to higher level of religious/spiritual importance, their mean GAS score improving by 4.6 points (P < .0001) over the next decade; that relation was of greater magnitude in sons with both lifetime MDD and a depressed parent.

CONCLUSIONS

Greater improvement in psychosocial functioning in relation to religious involvement in more vulnerable offspring supports religiosity as a resilience factor.

Religiosity and resilience in persons at high risk for major depression

BACKGROUND

Few studies have examined religiosity as a protective factor using a longitudinal design to predict resilience in persons at high risk for major depressive disorder (MDD).

METHOD

High-risk offspring selected for having a depressed parent and control offspring of non-depressed parents were evaluated for psychiatric disorders in childhood/adolescence and at 10-year and 20-year follow-ups. Religious/spiritual importance, services attendance and negative life events (NLEs) were assessed at the 10-year follow-up. Models tested differences in relationships between religiosity/spirituality and subsequent disorders among offspring based on parent depression status, history of prior MDD and level of NLE exposure. Resilience was defined as lower odds for disorders with greater religiosity/spirituality in higher-risk versus lower-risk offspring.

RESULTS

Increased attendance was associated with significantly reduced odds for mood disorder (by 43%) and any psychiatric disorder (by 53%) in all offspring; however, odds were significantly lower in offspring of non-depressed parents than in offspring of depressed parents. In analyses confined to offspring of depressed parents, those with high and those with average/low NLE exposure were compared: increased attendance was associated with significantly reduced odds for MDD, mood disorder and any psychiatric disorder (by 76, 69 and 64% respectively) and increased importance was associated with significantly reduced odds for mood disorder (by 74%) only in offspring of depressed parents with high NLE exposure. Moreover, those associations differed significantly between offspring of depressed parents with high NLE exposure and offspring of depressed parents with average/low NLE exposure.

CONCLUSIONS

Greater religiosity may contribute to development of resilience in certain high-risk individuals.

Clinical implications of research on religion, spirituality, and mental health

The relation between religion and (or) spirituality (RS), and mental health has shown generally positive associations; however, it is a complex and often emotion-laden field of study. We attempt to examine potential mechanisms that have been proposed as mediators for the RS and mental health relation. We also examine more philosophical areas including patient and physician opinions about inclusion of RS in patient care, and ethical issues that may arise. We review suggested guidelines for sensitive patient inquiry, and opportunities and challenges for education of psychiatrists and trainees. We also study practical ways to incorporate psychospiritual interventions into patient treatment, with specific reference to more common spiritual issues such as forgiveness, gratitude, and altruism.

Environmental factors in obsessive-compulsive behavior: evidence from discordant and concordant monozygotic twins

To investigate environmental factors that protect against or exacerbate obsessive-compulsive (OC) symptoms, we selected 25 monozygotic (MZ) twin pairs discordant, 17 MZ twin pairs concordant high and 34 MZ pairs concordant low on OC symptoms from a large longitudinal Dutch sample of adult twin pairs and their family members, applying stringent criteria for OC symptomatology. Data were collected on psychopathology, family structure, health, lifestyle, birth complications and life events. Unique environmental factors were studied using within-discordant MZ pair comparisons, whereas between-concordant MZ pair comparisons were used to study environmental factors that are shared by the twins of an MZ pair. The high-scoring MZ twins of the discordant group reported more life events (especially sexual abuse) than their low-scoring twin-siblings. The between-pair comparisons showed lower birth weight in the discordant MZ pairs than in the concordant MZ pairs. Further, the concordant high MZ pairs as well as their spouses had a lower educational level than the two other groups. On scale scores of anxious-depression, neuroticism, and somatic complaints, concordant high MZ pairs showed highest scores, and the discordant MZ pairs scored intermediate, except for neuroticism, on which the high-scoring twins of discordant MZ pairs were equal to the concordant high pairs. Discordance on psychological scale scores between the concordant MZ pairs was evident from 1991 onward, and within the discordant MZ pairs from 1997 onward, confirming previous reports of an association of early-onset OC symptoms with higher genetic load. Parent scores of OC symptoms and anxious-depression suggested intermediate genetic load in the discordant MZ group. In conclusion, this study reports on both unique and shared environmental factors associated with OC symptomatology. Whether these factors operate in addition to or in interaction with genetic disposition is to be elucidated in future studies.

Religious upbringing and neuroticism in Dutch twin families

Evidence for a relation between neuroticism and religion is scarce and inconsistent. The aims of the present study were to determine the association of religious upbringing with adult neuroticism scores and to examine the effect of religious upbringing on the heritability of neuroticism. As part of a longitudinal survey of twin families from the Netherlands Twin Register, data were collected on neuroticism and religious upbringing. Restricting the sample to persons aged 25 and over resulted in a sample of 4369 twins and 1304 siblings from 2698 families. Religious upbringing was significantly associated with neuroticism; in both men and women neuroticism levels were lower in those who had received a religious upbringing. There were no sex or twin sibling differences in neuroticism variances and covariances. Structural equation modeling showed differences in heritability between those with and without religious upbringing. In the group with religious upbringing, variation in neuroticism was determined for 41% by additive genetic factors and for the remaining 59% by unique environmental factors. In the group who had not received a religious upbringing, variation in neuroticism was determined for 55% by genetic factors, with evidence for both additive and nonadditive factors, and for the remaining 45% by unique environmental influences. In conclusion, having received a religious upbringing is associated with lower neuroticism scores and a lower heritability in adulthood.

Examining the links between spiritual struggles and symptoms of psychopathology in a national sample

The present study investigated the relationship between spiritual struggles and various types of psychopathology symptoms in individuals who had and had not suffered from a recent illness. Participants completed self-report measures of religious variables and symptoms of psychopathology. Spiritual struggles were assessed by a measure of negative religious coping. As predicted, negative religious coping was significantly linked to various forms of psychopathology, including anxiety, phobic anxiety, depression, paranoid ideation, obsessive-compulsiveness, and somatization, after controlling for demographic and religious variables. In addition, the relationship between negative religious coping and anxiety and phobic anxiety was stronger for individuals who had experienced a recent illness. These results have implications for assessments and interventions targeting spiritual struggles, especially in medical settings.

How spiritual values and worship attendance relate to psychiatric disorders in the Canadian population

OBJECTIVE

Research into risk and protective factors for psychiatric disorders may help reduce the burden of these conditions. Spirituality and religion are 2 such factors, but research remains limited. Using a representative national sample of respondents, this study examines the relation between worship frequency and the importance of spiritual values and DSM-IV psychiatric and substance use disorders.

METHOD

In 2002, the Canadian Community Health Survey obtained data from about 37,000 individuals aged 15 years or older. While controlling for demographic characteristics, we determined odds ratios for lifetime, 1-year, and past psychiatric disorders, with worship frequency and spiritual values as predictors.

RESULTS

Higher worship frequency was associated with lower odds of psychiatric disorders. In contrast, those who considered higher spiritual values important (in a search for meaning, in giving strength, and in understanding life's difficulties) had higher odds of most psychiatric disorders.

CONCLUSION

This study confirms an association between higher worship frequency and lower odds of depression and it expands that finding to other psychiatric disorders. The association between spiritual values and mood, anxiety, and addictive disorders is complex and may reflect the use of spirituality to reframe life difficulties, including mental disorders.

The differential impact of risk factors on illicit drug involvement in females

BACKGROUND

Initiation of drug use and progression to abuse/dependence involve complex pathways. Potential risk factors may correlate with initiation or progression or both. Are there risk factors that associate with illicit drug use or illicit drug abuse/dependence? Is the magnitude of the association the same for use and abuse/dependence? Does this pattern of association differ across categories of drugs?

METHODS

We used data from female-female adult twins to assess the association of 26 putative risk factors with use and abuse/dependence of six illicit psychoactive drugs. Drug involvement was represented by independent dichotomous outcomes and by a single ordinal variable. Odds ratios were obtained by logistic regression and a continuation ratio was used to test the magnitude of association.

RESULTS

Factors associate in similar patterns with different drug categories. Some associated factors interact only with initiation while others relate with both stages. There is a stronger association of significant socio-demographic factors with drug use while the psychiatric diagnoses are more strongly associated with progression to abuse/dependence.

CONCLUSIONS

Risk factors may be use-specific, abuse/dependence-specific or common to use and abuse/dependence. The trend of associations is similar across different illicit drugs. This suggests complex, interacting pathways that determine drug habits in individuals. These results are hypothesis-generating and future studies of causal relationships may draw from the outcomes presented in these analyses.

Longitudinal effects of age at onset and first drinking situations on problem drinking

The purpose of this study was to describe aspects of the first alcohol-use experience, and examine the predictive relations among age of first use, context of alcohol use initiation, and problem drinking with and without controls for psychosocial risk factors. Data were from the Rutgers Health and Human Development Project, a five-wave, prospective study of substance-use behaviors in a community sample. Respondents, who were first interviewed at age 12 (1979-81) and most recently at age 30 or 31 (1999-2000) (N=371), reported on their first drinking experience, and on a range of known risk factors for alcohol abuse. Most alcohol initiation occurred during a family gathering. Regardless of initiation context, youth who drank at an early age were more likely than youth who initiated later to become problem drinkers, although the risk was relatively greater for the youth who first drank outside a family gathering. Based on multivariate logistic regressions, feeling drunk at initiation was the only onset-related variable significantly associated with problem drinking; other significant risks factors included male gender, delinquency, and family history of alcoholism. Because most initiation occurs at a family gathering, alcoholism prevention research may benefit from examining the role that drinking in family contexts could play with regard to socializing young drinkers to less risky drinking behaviors in adulthood. In particular, further research focusing on the subjective effects experienced by youth when they first drink may be merited.

Relation of intelligence and religiosity to depressive disorders in offspring of depressed and nondepressed mothers

OBJECTIVE

To examine the relation of IQ and religiosity to depressive disorders in adolescents who varied with respect to the chronicity of their mothers' depression history.

METHOD

Participants were 240 adolescents first evaluated when they were in 6th grade and then annually for 6 years. Adolescents' depressive diagnoses were assessed initially with the Schedule for Affective Disorders and Schizophrenia for School-Age Children and then annually with the Longitudinal Interval Follow-up Evaluation for children.

RESULTS

IQ, but not religiosity, moderated the relation between chronicity of maternal depression and depressive disorders in adolescents. For children of mothers with no or less chronic depression, higher IQ was associated with a lower likelihood of depression; in contrast, for children of mothers with a history of more chronic depression, higher levels of IQ were significantly associated with a greater likelihood of depression. Depressive episodes during grades 7 through 11 predicted lower religious attendance during 12th grade, controlling for prior religiosity. There also was a marginally significant trend for religious attendance in 6th grade to predict lower odds of developing depressive diagnoses during grades 7 through 12.

CONCLUSIONS

These results highlight the complex relation between IQ and depression and indicate the possibility of a bidirectional relation between religious attendance and adolescent depression.

Religiosity, depression, and physical maturation in adolescent girls

OBJECTIVE

To assess the impact of physical maturation on the protective qualities of religiosity against depression in adolescent girls.

METHOD

Subjects were 3,356 adolescent girls (mean age 16.0, SD = 1.8) interviewed in 1995 as part of the Wave I In-Home Version of the North Carolina Adolescent Health Study. Maturation was assessed on the basis of self-report of secondary sexual characteristics and age at onset of menstruation. Religiosity was assessed on the basis of personal devotion, personal conservatism, institutional conservatism, and participation in religious community. Logistic regression analyses were conducted with each variable of religiosity used to predict depression, controlling for age and ethnicity.

RESULTS

Personal devotion and participation in religious community were associated with a 19% to 26% decreased likelihood of depression in non-highly mature girls and a relatively more robust 32% to 43% decreased likelihood of depression in highly mature girls. Personal conservatism and institutional conservatism were associated with a 17% to 24% decreased likelihood of depression among non-highly mature girls, but were not associated with depression in highly mature girls.

CONCLUSION

Physical maturation may be associated with the protective qualities of religiosity against depression in adolescent girls.