spiritual and religious factors in depression: the state of the science michael e. mccullough...

Spiritual and Religious Spiritual and Religious Factors in DepressionFactors in Depression : : The State of the ScienceThe State of the Science

Michael E. McCulloughMichael E. McCullough

University of MiamiUniversity of Miami

Religion and Health: Religion and Health: Damned by Overstatement?Damned by Overstatement?

““Based on the research data we Based on the research data we how have at hand, your doctor how have at hand, your doctor could--from a strictly scientific could--from a strictly scientific point of view--recommend point of view--recommend religious involvement to religious involvement to improve your chances of improve your chances of being able to . . . Stay healthy being able to . . . Stay healthy and avoid life-threatening and and avoid life-threatening and disabling diseases like cancer disabling diseases like cancer and heart disease...[and] live and heart disease...[and] live longer.” (p. 15).longer.” (p. 15).

Religion and Health: Religion and Health: Damned by Damned by Understatement?Understatement?

““Serious methodological Serious methodological and empirical issues and empirical issues continue to plague the continue to plague the literature on religion literature on religion and health. Even well-and health. Even well-conducted studies conducted studies demonstrate only a demonstrate only a weak or nonexistent weak or nonexistent association.” (p. 350)association.” (p. 350)

Our ApproachOur Approach

Based on Based on ALLALL available evidence, what can we available evidence, what can we say about the relationship of religious/spiritual say about the relationship of religious/spiritual factors and health (viz., depression)?factors and health (viz., depression)?

For whom, and under what conditions, does the For whom, and under what conditions, does the association apply?association apply?

What do we know about the temporal dynamics What do we know about the temporal dynamics of the association?of the association?

What are the active ingredients?What are the active ingredients?

Religiousness and Well-Being Religiousness and Well-Being in Adulthoodin Adulthood

Meta-analysis of 56 Meta-analysis of 56 effect sizeseffect sizes

Mean ES of Mean ES of rr = .16 = .16 Mean ES for religious Mean ES for religious

activity of activity of rr = .18 = .18 Mean ES for subjective Mean ES for subjective

religiousness of religiousness of rr = .13 = .13

Witter et al. (1985)Witter et al. (1985)

00.020.040.060.080.10.120.140.160.180.2

N = 34,706, National Opinion Research Center, 1972-1996

Dimensions of Religiousness and Likelihood of Diagnosis with Nine Major Mental Disorders

Kendler et al., 2002

Religiousness and Religiousness and Recovery from Recovery from DepressionDepression

87 patients aged 87 patients aged 60 admitted for physical illness 60 admitted for physical illness with co-morbid depression.with co-morbid depression.

Patients with higher intrinsic religiousness scores Patients with higher intrinsic religiousness scores (score range 10-50) experienced faster recovery(score range 10-50) experienced faster recovery

Every 10 point increase in intrisinc religiousness score Every 10 point increase in intrisinc religiousness score associated with 70% increase in speed of remission.associated with 70% increase in speed of remission.

Koenig HG, et al.Koenig HG, et al. Am J Psychiatry 1998;155(4):536-542Am J Psychiatry 1998;155(4):536-542

Religion and Religion and Depression: A Meta-Depression: A Meta-Analytic SummaryAnalytic Summary

Meta-AnalysisMeta-Analysis

A family of statistical methods for aggregating A family of statistical methods for aggregating observations from multiple studies observations from multiple studies

Each study contributes an estimate of the Each study contributes an estimate of the association of religious involvement and mortalityassociation of religious involvement and mortality

Estimates aggregated into one population estimateEstimates aggregated into one population estimate

Advantages of Meta-Advantages of Meta-AnalysisAnalysis

Allows researchers to examine the Allows researchers to examine the consistency of findings across studiesconsistency of findings across studies

Permits statistically based estimates for an Permits statistically based estimates for an entire body of researchentire body of research

Permits empirical investigation of the sources Permits empirical investigation of the sources of variability among studiesof variability among studies

Weaknesses of Meta-Weaknesses of Meta-AnalysisAnalysis

Garbage In, Garbage OutGarbage In, Garbage Out

Apples and OrangesApples and Oranges

Publication Bias (or the “File Drawer” Publication Bias (or the “File Drawer” Problem)Problem)

ResultsResults

150 Studies150 Studies

Mean Correlation of Mean Correlation of Religiousness and Religiousness and Depressive Symptoms Depressive Symptoms = -.126= -.126

Findings almost = for Findings almost = for both genders and both genders and across ethnic groupsacross ethnic groups

Effects of Positive vs. Effects of Positive vs. Negative Religious Negative Religious CopingCoping

Effects of Intrinsic vs. Effects of Intrinsic vs. Extrinsic ReligiousnessExtrinsic Religiousness

Age differencesAge differences

Smith, McCullough, & Poll, 2003

Religion and Depression Religion and Depression Over the Life CourseOver the Life Course

-0.4-0.3-0.2-0.1

00.1

Age Group

Mea

n r

(95%

CI)

Upper Bound -0.18 -0.17 -0.25 -0.14 -0.1 -0.13 -0.22 -0.3

Lower Bound 0.05 -0.09 -0.09 -0.07 -0.01 -0.01 -0.14 -0.07

Mean r -0.061 -0.129 -0.171 -0.105 -0.051 -0.073 -0.179 -0.207

13-18 19-24 25-35 36-45 46-55 56-65 66-75 75+

Religious and Spiritual Religious and Spiritual Coping With StressCoping With Stress

Stress Buffering EffectsStress Buffering Effects

Level of Stress Correlation

Minimal Stress -.10

Mild/ModerateStress -.17

Severe Stress -.18

How Do People Use Religious How Do People Use Religious and Spiritual Beliefs to Cope?and Spiritual Beliefs to Cope?

Styles of Religious CopingStyles of Religious Coping Self-DirectingSelf-Directing DeferringDeferring CollaborativeCollaborative

Specific Ways of Religious CopingSpecific Ways of Religious Coping Positive vs. NegativePositive vs. Negative Specific Religious Coping Processes Specific Religious Coping Processes

(Demonic Reappraisal, Seeking (Demonic Reappraisal, Seeking Congregational Support, etc.)Congregational Support, etc.)

Pargament, Smith, Koenig, & Perez, 1998

Religious Coping Among Religious Coping Among Hindus (Tarakeshwar et al., Hindus (Tarakeshwar et al.,

2003)2003)

Religious Coping Among Religious Coping Among Hindus (Tarakeshwar et al., Hindus (Tarakeshwar et al.,

2003)2003)

Religious Coping Among Religious Coping Among Hindus (Tarakeshwar et al., Hindus (Tarakeshwar et al.,

2003)2003)

Exploring Temporal Exploring Temporal DynamicsDynamics

Daily Diary Study of Religion for Daily Diary Study of Religion for Coping With Pain (Keefe et al., 2001)Coping With Pain (Keefe et al., 2001)

Religion and Emotional Religion and Emotional Compensation Among Widows Compensation Among Widows (Brown et al., 2004)(Brown et al., 2004)

2.5

3.0

3.5

4.0

4.5

5.0

20 30 40 50 60 70 80 90

Age

Sel

f-R

ated

Hea

lth

Mean Religiousness

+1 SD Religiousness

-1 SD Religiousness

2.5

3.0

3.5

4.0

4.5

5.0

20 30 40 50 60 70 80 90

Age

Sel

f-R

ated

Hea

lth

Mean Religiousness

+1 SD Religiousness

-1 SD Religiousness

Religion and Age-Related Declines in Religion and Age-Related Declines in Self-Rated HealthSelf-Rated Health

McCullough & Laurenceau, 2005McCullough & Laurenceau, 2005

Spiritual StrengthsSpiritual Strengths

GratitudeGratitude ForgivenessForgiveness Hope/OptimismHope/Optimism Humility/Accurate Self-EsteemHumility/Accurate Self-Esteem Control of the SelfControl of the Self (Giving and Receiving) Love(Giving and Receiving) Love

The Religion-Mental Health The Religion-Mental Health Connection: Not MagicConnection: Not Magic

““It seems to me most It seems to me most important for the whole important for the whole problem of religion and problem of religion and health to recognize that health to recognize that the magical world view is the magical world view is not religion. . .Religion is not religion. . .Religion is not magic, and magic is not magic, and magic is not religion.”not religion.”

Paul Tillich, 1958, “Religion and Health”Paul Tillich, 1958, “Religion and Health”