Spiritual and Religious Factors in Depression: The State of the Science Michael E. McCullough University of Miami

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

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

Our Approach  Based on ALL available evidence, what can we say about the relationship of religious/spiritual factors and health (viz., depression)?  For whom, and under what conditions, does the association apply?  What do we know about the temporal dynamics of the association?  What are the active ingredients?

Religiousness and Well-Being in Adulthood  Meta-analysis of 56 effect sizes  Mean ES of r =.16  Mean ES for religious activity of r =.18  Mean ES for subjective religiousness of r =.13 Witter et al. (1985)

N = 34,706, National Opinion Research Center,

Dimensions of Religiousness and Likelihood of Diagnosis with Nine Major Mental Disorders Kendler et al., 2002

Religiousness and Recovery from Depression 87 patients aged  60 admitted for physical illness with co-morbid depression. 87 patients aged  60 admitted for physical illness with co-morbid depression. Patients with higher intrinsic religiousness scores (score range 10-50) experienced faster recovery Patients with higher intrinsic religiousness scores (score range 10-50) experienced faster recovery Every 10 point increase in intrisinc religiousness score associated with 70% increase in speed of remission. Every 10 point increase in intrisinc religiousness score associated with 70% increase in speed of remission. Koenig HG, et al. Am J Psychiatry 1998;155(4): Koenig HG, et al. Am J Psychiatry 1998;155(4):

Religion and Depression: A Meta- Analytic Summary

Meta-Analysis  A family of statistical methods for aggregating observations from multiple studies  Each study contributes an estimate of the association of religious involvement and mortality  Estimates aggregated into one population estimate

Advantages of Meta- Analysis  Allows researchers to examine the consistency of findings across studies  Permits statistically based estimates for an entire body of research  Permits empirical investigation of the sources of variability among studies

Weaknesses of Meta- Analysis  Garbage In, Garbage Out  Apples and Oranges  Publication Bias (or the “File Drawer” Problem)

Results  150 Studies  Mean Correlation of Religiousness and Depressive Symptoms =  Findings almost = for both genders and across ethnic groups  Effects of Positive vs. Negative Religious Coping  Effects of Intrinsic vs. Extrinsic Religiousness  Age differences Smith, McCullough, & Poll, 2003

Religion and Depression Over the Life Course

Religious and Spiritual Coping With Stress

Stress Buffering Effects

How Do People Use Religious and Spiritual Beliefs to Cope?  Styles of Religious Coping  Self-Directing  Deferring  Collaborative  Specific Ways of Religious Coping  Positive vs. Negative  Specific Religious Coping Processes (Demonic Reappraisal, Seeking Congregational Support, etc.)

Pargament, Smith, Koenig, & Perez, 1998

Religious Coping Among Hindus (Tarakeshwar et al., 2003)

Exploring Temporal Dynamics

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

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

Religion and Age-Related Declines in Self-Rated Health McCullough & Laurenceau, 2005

Spiritual Strengths  Gratitude  Forgiveness  Hope/Optimism  Humility/Accurate Self-Esteem  Control of the Self  (Giving and Receiving) Love

The Religion-Mental Health Connection: Not Magic “It seems to me most important for the whole problem of religion and health to recognize that the magical world view is not religion...Religion is not magic, and magic is not religion.” Paul Tillich, 1958, “Religion and Health”