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Religiousness and Depression: Evidence for a Main Effect and the Moderating Influence of Stressful Life Events

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Religiousness and Depression: Evidence for a Main Effect and the Moderating Influence of Stressful Life Events Psychological Bulletin Copyright 2003 by the American Psychological Association, Inc. 2003, Vol. 129, No. 4, 614–636 0033-2909/03/$12.00 DOI: 10.1037/0033-2909.129.4.614 Religiousness and Depression: Evidence for a Main Effect and the Moderating Influence of Stressful Life Events Timothy B. Smith Michael E. McCullough Brigham Young University University of Miami Justin Poll Brigham Young University The association between religiousness and depressive symptoms was examined with meta-analytic methods across 147 independent investigations (N ϭ 98,975). Across all studies, the correlation between religiousness and depressive symptoms was –.096, indicating that greater religiousness is mildly associated with fewer symptoms. The results were not moderated by gender, age, or ethnicity, but the religiousness–depression association was stronger in studies involving people who were undergoing stress due to recent life events. The results were also moderated by the type of measure of religiousness used in the study, with extrinsic religious orientation and negative religious coping (e.g., avoiding difficulties through religious activities, blaming God for difficulties) associated with higher levels of depressive symptoms, the opposite direction of the overall findings. Depression and depressive symptoms are among the most com- factors that may be useful for improving its detection and diagno- mon of all mental disorders and health complaints. Worldwide, as sis. Well-established risk factors include (a) genetic factors (Na- many as 330 million people may suffer from depression at any tional Institute of Mental Health Genetics Workgroup, 1998); (b) given time, with prevalence estimates ranging from 2%–3% for gender (Nolen-Hoeksema, Larson, & Grayson, 1999); (c) social men and 5%–12% for women (American Psychiatric Association, isolation (Barnett & Gotlib, 1988; Joiner & Coyne, 1999; Lara, 2000). Approximately 20 million visits to physicians in 1993– Leader, & Klein, 1997); (d) personality traits such as dependency, 1994 involved reports of depressive symptoms (Pincus et al., Introversion, and Neuroticism (Barnett & Gotlib, 1988; Jorm et al., 1998). Depression is costly as well as prevalent: The worldwide 2000); and (e) stressful life events (e.g., Monroe & Simons, 1991; market for antidepressants in 1998 was approximately $7 billion Nolen-Hoeksema & Morrow, 1991). (“Spirit of the Age,” 1998). In the United States alone, approxi- Another variable that has recently received attention in the mately $12 billion in labor is lost to depressive symptoms each depression literature is religious involvement. Several recent high- year. Moreover, depression is also a leading cause of physical profile studies (e.g., Braam et al., 2001; Koenig, George, & Peter- disability and has even been found to be a risk factor for cardio- son, 1998; Murphy et al., 2000) indicate that certain aspects of vascular mortality (Saz & Dewey, 2001; Wulsin, Vaillant, & religiousness (e.g., public religious involvement, intrinsic religious Wells, 1999). motivation) may be inversely related to depressive symptoms Given the prevalence of depression and the burdens it creates, (with greater religious involvement associated with fewer symp- investigators have spent a great deal of effort trying to identify toms of depression). Of note, Braam et al. (2001) reported that public religious involvement (viz., church attendance) was in- versely related to depression among older individuals from Euro- Timothy B. Smith and Justin Poll, Department of Counseling Psychol- pean countries that were included in the EURODEP collaboration. ogy, Brigham Young University; Michael E. McCullough, Department of Also Koenig, George, and Peterson (1998) reported that among Psychology, University of Miami. clinically depressed older adults, intrinsic religiousness was Work on this article was supported by grants from the John Templeton strongly associated with the speed with which individuals’ depres- Foundation, the Campaign for Forgiveness Research, TP Industrials Inc., sive episodes abated, even after controlling for a variety of poten- and the Religious Research Association. We thank Sharon Black, Rick tial confounds. Reviewers of the overall literature on religion and Ingram, and Michael Lambert for their helpful comments on previous depression (e.g., Koenig, McCullough, & Larson, 2001; McCul- versions of this article and Brandon Dickson, Tiffany Martin, and Jim lough & Larson, 1999) have reached similar conclusions. Scriber for their work as coders. Studies on these issues have been accumulating for more than Correspondence concerning this article should be addressed to Timothy 100 years (see McCullough & Larson, 1999). Indeed, studies as far B. Smith, Department of Counseling Psychology, Brigham Young Univer- sity, 340 MCKB, Provo, Utah 84602-5093 or to Michael E. McCullough, back as the 1880s have pointed to religion as a possible influence Department of Psychology, University of Miami, P.O. Box 248185, Coral on the occurrence and severity of depression (Koenig et al., 2001). Gables, Florida 33124-2070. E-mail: [email protected] or mmccullough@ Given the perceived size and scope of this literature, scholars have umiami.ir.miami.edu recently recommended that investigators quantify and summarize 614 RELIGIOUSNESS AND DEPRESSIVE SYMPTOMS 615 this literature through meta-analysis so that the potential utility of individual to depression and contribute to a lack of interest in religiousness as a predictor of depressive symptoms could be religious matters (Hunsberger, 1980). It may also be that some assessed more objectively (McCullough & Larson, 1998), just as individuals seek out religion to compensate for poor relationships recent meta-analytic work has contributed to understanding of the with parents (Granqvist, 1998; Kirkpatrick & Shaver, 1990). nature of the relationship of religiousness and longevity (McCul- lough, Hoyt, Larson, Koenig, & Thoresen, 2000). A similar meta- analysis on the relationship of religiousness and depressive symp- Depressive Influences on Religiousness toms also would permit an examination of several subsidiary In addition to the possibility that the associations between questions. religiousness and depression are influenced by common develop- mental factors, there are good reasons to believe that depressive Possible Mechanisms of Association symptoms might influence religiousness. People who are experi- encing high levels of depressive symptoms may find a lack of If religiousness and depressive symptoms are indeed related, pleasure in former religious involvements, which may over time what factors influence that relationship? It is challenging to offer erode their public and even private engagements with their reli- a theoretical account that is both elegant and comprehensive be- gious faith. Moreover, to the extent that a person’s depressive cause research has yet to confirm which variables moderate the symptoms include a lack of energy or a physical disability, previ- relationship, let alone which variables mediate it. Identification of ously religious people may find themselves unable to engage in moderating and mediating variables is important but difficult be- religious pursuits, by extension making them seem less religious cause both religiousness and depressive symptoms are influenced on many metrics for assessing religiousness. On the other hand, by a host of biological, social, and psychological factors. To depressive symptoms apparently prompt some people to seek complicate matters, the variables with which religion and depres- comfort in their religion (e.g., by attending religious services or sion are correlated typically are not exclusively one-way relation- reading holy scripture), which might, de facto, increase their ships: Because of the possibility of reciprocal relationships, many apparent religiousness (Ferraro & Kelley-Moore, 2000). factors that are believed to be causes of depression may also be consequences of depression, and the same is true of religiousness. Regardless, insofar as a relationship between religiousness and Religious Influences on Depressive Symptoms depressive symptoms does exist, any of a variety of mechanisms might explain the association. Previous research suggests some Another possibility, that factors associated with religiousness possibilities that should inform future efforts, although not all of influence symptoms of depression, has received the most attention these possibilities can be addressed with meta-analytic methods at in the recent empirical literature. Many researchers have suggested present. that religiousness may reduce vulnerability to depressive symp- toms by way of a variety of substantive psychosocial mechanisms. Potentially Common Influences on Religiousness and Although an exhaustive list of these potential mechanisms is not Depressive Symptoms feasible here, we illustrate with four possible mechanisms. (For a more extensive review, see Koenig et al., 2001.) Genetic influences. Religiousness might be associated with Lower substance use. National surveys point to high rates of depressive symptoms because of similar genetic influences. Sev- comorbidity between depressive symptoms and both drug abuse eral studies suggest that 40%–50% of the variance in religiousness and drug dependence (Grant, 1995), which suggests that drug may be attributable to additive genetic factors (D’Onofrio, Eaves, abuse and dependence may be risk factors for the development of Murrelle, Maes, & Spilka, 1999; Waller, Kojetin,
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