Mental Disorders, Religion and Spirituality 1990 to 2010: A Systematic Evidence-Based Review

Religion/spirituality has been increasingly examined in medical research during the past two decades. Despite the increasing number of published studies, a systematic evidence-based review of the available data in the field of psychiatry has not been done during the last 20 years. The literature was searched using PubMed (1990–2010). We examined original research on religion, religiosity, spirituality, and related terms published in the top 25 % of psychiatry and neurology journals according to the ISI journals citation index 2010. Most studies focused on religion or religiosity and only 7 % involved interventions. Among the 43 publications that met these criteria, thirty-one (72.1 %) found a relationship between level of religious/spiritual involvement and less mental disorder (positive), eight (18.6 %) found mixed results (positive and negative), and two (4.7 %) reported more mental disorder (negative). All studies on dementia, suicide, and stress-related disorders found a positive association, as well as 79 and 67 % of the papers on depression and substance abuse, respectively. In contrast, findings from the few studies in schizophrenia were mixed, and in bipolar disorder, indicated no association or a negative one. There is good evidence that religious involvement is correlated with better mental health in the areas of depression, substance abuse, and suicide; some evidence in stress-related disorders and dementia; insufficient evidence in bipolar disorder and schizophrenia, and no data in many other mental disorders.     

Parental religiosity,abuse history and maintenance of beliefs taught in the family

Both anecdotal and empirical investigations have indicated that childhood sexual abuse may negatively impact one's religiosity as an adult. However, few studies have examined the impact of other forms of abuse on the development of religiosity. In the present study, 167 participants recruited from a Pacific Northwest university completed questionnaires measuring parental religiosity, as well as both physical and emotional abuse history, to assess the impact of these factors on the participants’ maintenance of beliefs taught in the family. Results demonstrated that report of abuse was negatively associated with belief maintenance. Alternatively, parental religiosity was positively associated with belief maintenance, and negatively associated with report of abuse. These findings are discussed in terms of social learning theory and the lifestyle behaviours of religious individuals.     

Religiosity and Risky Sexual Behaviors among an African American Church-based Population

African Americans are disproportionately burdened by STDs and HIV in the US. This study examined the relationships between demographics, religiosity, and sexual risk behaviors among 255 adult African American church-based participants. Although participants were highly religious, they reported an average of seven lifetime sex partners and most inconsistently used condoms. Several demographic variables and religiosity significantly predicted lifetime HIV-related risk factors. Taken together, findings indicated that this population is at risk for HIV. Future research should continue to identify correlates of risky sexual behavior among African American parishioners to facilitate the development of HIV risk reduction interventions in their church settings.     

Substance Abuse,Familial Factors,and Mental Health: Exploring Racial and Ethnic Group Differences Among African American,Caucasian, and Hispanic Juvenile Offenders

The present study examined racial, ethnic, and gender differences in family composition substance abuse, and mental health issues, such as depression and self-esteem among adjudicated juvenile offenders. Results revealed a negative relationship between depression and self-esteem among all ethnicities and family compositions. Caucasians reported greater incidence of substance abuse than did African American and Hispanic youth. Moreover, in reconstituted families, Caucasians had lower self-esteem scores than did other ethnicities. The findings illustrate the complexities of risk to substance use among high-risk populations, particularly as they relate to familial factors and the importance of intensive family therapy among this population.     

Motivational enhancement therapy for African American substance users: a randomized clinical trial

Limited empirical evidence concerning the efficacy of substance abuse treatments among African Americans reduces opportunities to evaluate and improve program efficacy. The current study, conducted as a secondary analysis of a randomized clinical trial conducted by the Clinical Trials Network of the National Institute of Drug Abuse, addressed this knowledge gap by examining the efficacy of motivational enhancement therapy (MET) compared with counseling as usual (CAU) among 194 African American adults seeking outpatient substance abuse treatment at 5 participating sites. The findings revealed higher retention rates among women in MET than in CAU during the initial 12 weeks of the 16-week study. Men in MET and CAU did not differ in retention. However, MET participants self-reported more drug-using days per week than participants in CAU. Implications for future substance abuse treatment research with African Americans are discussed.     

Religiosity and Social Support: Implications for the Health-Related Quality of Life of African American Hemodialysis Patients

The purpose of this study was to determine whether sociocultural differences have any effect on the health-related quality of life among African American hemodialysis patients. This study examined relationships between religiosity, social support, and the health-related quality of life of African American hemodialysis patients. Four hemodialysis units were selected for the study. The study population consisted of 176 African American hemodialysis patients who had been receiving hemodialysis treatments for at least 1 month. The religiosity variable was measured by the Measure of Religious Involvement. Social Support was measured by the Medical Outcomes Study Social Support Survey, and health-related quality of life was measured by the Medical Outcomes Study 36 Short Form Health Survey (SF-36v2). The investigators found that social support contributed to the emotional and physical health of African American hemodialysis patients in the sample, whereas religiosity was inversely related to the physical health of these patients.     

Associations between depression, distress tolerance, delay discounting, and alcohol-related problems in European American and African American college students

Although levels of heavy drinking and alcohol-related problems are high in college students, there is significant variability in the number and type of problems experienced, even among students who drink heavily. African American students drink less and experience fewer alcohol-related problems than European American students, but are still at risk, and little research has investigated the potentially unique patterns and predictors of problems among these students. Depression, distress tolerance, and delay discounting have been implicated in adult substance abuse and may be important predictors of alcohol problem severity among college students. We examined the relationship between these variables and alcohol-related problems among African American and European American students (N = 206; 53% female; 68% European American; 28% African American) who reported recent heavy drinking. In regression models that controlled for drinking level, depression, distress tolerance, and delay discounting were associated with alcohol problems among African American students, but only depression was associated with alcohol problems among European American students. These results suggest that negative affect is a key risk factor for alcohol problems among college student drinkers. For African American students, the inability to tolerate negative emotions and to organize their behavior around future outcomes may also be especially relevant risk factors.     

Religiosity and adolescent marijuana use

Among adolescents, religiosity has been associated with lower rates of marijuana use, though few studies have examined its impact on the perceived risk of use. There is strong support that perceived risk of using marijuana is negatively correlated with the frequency of use. We examined the relationship among religiosity, perceived risk, and marijuana use from a national survey of adolescents that contained questions about lifetime, weekly, and past month substance use, social support, religious involvement and attitudes, and perceived riskiness of use. We tested a structural equation model of relationships among latent variables of religiosity and perceived risk, and an observed variable of total days of marijuana use in the past 12 months. Results indicated the model was a good fit to the data and described a mediating relationship of perceived risk of use between religiosity and marijuana use. Implications for leveraging religiosity in prevention of substance use are discussed.     

Risk and Protective Processes Predicting Rural African American Young Men's Substance Abuse

Informed by a life course perspective, this study tested a cascade model linking harsh, unresponsive parenting during childhood to young African American men's substance abuse via precocious transitions, economic instability, and future orientation. The moderating influence of community disadvantage and romantic partner support on the hypothesized pathways was also examined. At the baseline, the sample included 505 African American men between ages 19 and 22 years from high‐poverty rural communities. Follow‐up data were collected 18 months after baseline. Using structural equation modeling, we identified harsh, unresponsive parenting influenced precocious transitions in adolescence, which in turn increased economic instability during young adulthood. Economic instability was associated with a reduction in future orientation, a proximal influence on increases in substance abuse. Also, residence in a disadvantaged community amplified the influence of precocious transitions on economic instability and the influence of economic instability on future orientation. Involvement with supportive romantic partnership evinced a protective effect, attenuating the influence of precocious transitions on economic instability and the influence of economic instability on a future orientation. This study expands understanding of young adults’ substance abuse by demonstrating the risk and protective processes linking substance abuse to developmental factors across childhood, adolescence, and young adulthood.     

A Study of Religiosity and Psychological Well-being Among African Americans: Implications for Counseling and Psychotherapeutic Processes

This study examined whether a relationship exists between religious orientation as a therapy intervention and the degree of depression, coping behavior and self-esteem among African American adults. In addition, the relationship and predictive power of selected religious and socio-demographic variables and religious orientation as a therapy intervention were studied. African American adults were randomly selected to participate in this empirical study. Age had a significant independent effect on intrinsic religiosity and extrinsic religiosity and a linear relationship was found between extrinsic religiosity and the seven demographic predictor variables at the .05 level of significance.     

Discriminators of suicide thoughts and attempts among homeless veterans who abuse substances

Six hundred homeless military veterans who abused substances were examined to determine what factors discriminate between nonsuicidal veterans, those who had suicidal thoughts, and persons who had attempted suicide. Several factors were considered based on attachment theory, including caregiver attachment, sexual abuse, physical abuse, resilience, self-efficacy, and self-esteem. Suicide attempters were discriminated from others by psychiatric comorbidity, early abuse, severity of substance abuse, and longevity of drug use. In contrast, the discriminators between nonsuicidal homeless substance abusers and others were elements of attachment and commitments such as marriage, employment, and religiosity. Some implications of the findings for intervention are discussed.     

The Relationship Between Perceptions of Neighborhood Characteristics and Substance Use Among Urban African American Adolescents

Although the neighborhood microsystem is recognized as an important domain for adolescent development, relative to the family and peer contexts, neighborhood factors have been understudied in relation to adolescent substance abuse. In addition, recent research suggests that risk factors for adolescent substance use may differ for African Americans when compared to Caucasian youth. This study investigated the association between perceived neighborhood disorganization and later substance use, as well as possible mediators of that association, among a community sample of urban African American adolescents. Perceptions of neighborhood disorganization (i.e., violence/safety and drug activity) in grade 7 were associated with increased tobacco, alcohol, and marijuana use in grade 9. For females, this association was mediated by attitudes about drug use and perceptions of drug harmfulness. Findings highlight the importance of neighborhood contextual variables for African American substance use. Implications and directions for future research are presented.     

Social and emotional outcomes of childhood sexual abuse: A review of recent research

A total of 41 articles examined the social and emotional outcomes of childhood sexual abuse. The outcomes examined included suicide and substance use, gang involvement, pregnancy, running away, post-traumatic stress disorder (PTSD), risky sexual behavior, and behavioral problems. Results for each of these outcomes tended to vary by developmental period. However, problems of internalizing and externalizing behavior appeared to be specific to sexually abused children of all age groups. Some studies found differences in outcome according to gender, race, and age. Although findings related to abuse characteristics were found to vary from study to study, severity of the abuse, use of force, and victim's relationship to the perpetrator were found to be especially important. Other factors, such as family support and parental monitoring, were found to mitigate a negative outcome. Limitations are discussed along with suggestions for future research.     

Does Defensiveness Account for the Relationship Between Religiosity and Psychosocial Adjustment?

Religiosity has been related to positive psychosocial adjustment across a large number of studies. Some researchers question, however, whether this relationship is an accurate finding, observing that there are many potential confounds that have not been controlled for, such as defensiveness. This study examined whether defensiveness accounted for the relationship between religiosity and psychosocial adjustment. Two samples of religious individuals were assessed on religiosity (Duke University Religion Index), defensiveness (measured using the denial of distress and repressive defensiveness subscales from the Weinberger Adjustment Inventory [WAI]), and psychosocial adjustment (Depression subscale from the WAI, the Perceived Stress Scale, and the Sarason Social Support Scale). In both studies it was found that religiosity was related to positive psychosocial adjustment as well as higher levels of defensiveness. Defensiveness, however, did not account for the relationships between religiosity and psychosocial adjustment. These findings add to the research literature by eliminating a potential confound of the relationship between religiosity and psychosocial adjustment.     

Spirituality and Subjective Religiosity among African Americans, Caribbean Blacks and Non-Hispanic Whites

Patterns and correlates of self-perceptions of spirituality and subjective religiosity are examined using data from the National Survey of American Life, a nationally representative study of African Americans, Caribbean Blacks and non-Hispanic Whites. Demographic and denominational correlates of patterns of subjective religiosity and spirituality (i.e., religious only, spiritual only, both religious/spiritual and neither religious/spiritual) are examined. In addition, the study of African Americans and Caribbean Blacks permits the investigation of possible ethnic variation in the meaning and conceptual significance of these constructs within the U.S. Black population. African Americans and Caribbean Blacks are more likely than Non-Hispanic Whites to indicate that they are "both religious and spiritual" and less likely to indicate that they are "spiritual only" or "neither spiritual nor religious." Demographic and denominational differences in the patterns of spirituality and subjective religiosity are also indicated. Study findings are discussed in relation to prior research in this field and noted conceptual and methodological issues deserving further study.     

Sexual Prejudice among Christian College Students, Denominational Teachings, and Personal Religious Beliefs

Although numerous studies have examined the role of religious tradition and religiosity on attitudes toward lesbian, gay, and bisexual people, the role of endorsement of denominational teachings has largely been overlooked, even though such teachings are often cited to explain study findings. To better understand the complex relationship between religion and sexual prejudice, this study explores the unique contributions of religious tradition, religiosity, and individual endorsement of denominational doctrine about same-sex sexuality in shaping these attitudes. Findings indicate that endorsement of denominational doctrine concerning same-sex sexuality is more influential than religiosity, and that endorsement of denominational doctrine is not simply a proxy for believing that same-sex sexuality is a sin. Implications for future research are discussed.     

Academic achievement and behavioral health among Asian American and African American adolescents: testing the model minority and inferior minority assumptions

The present study tested the model minority and inferior minority assumptions by examining the relationship between academic performance and measures of behavioral health in a subsample of 3,008 (22 %) participants in a nationally representative, multicultural sample of 13,601 students in the 2001 Youth Risk Behavioral Survey, comparing Asian Americans (N = 408) and African Americans (N = 2,600). Specifically, the study examined associations of students’ self-reported grades with suicide risk, substance abuse, and violent behaviors. The findings revealed that high academic performance is a protective factor against behavioral health problems for both ethnic groups. The results raise questions about the focus on high achievement among Asian Americans versus academic underachievement among African Americans. Implications for theory, research, training and practice in addressing the mental health implications of achievement behavior in Asian American and African American youth are discussed.     

Religiosity of young adults: does childhood maltreatment make a difference?

Previous research on the association between maltreatment in childhood and later religious beliefs and behaviours suggests that maltreatment may have either negative or positive influences on religiosity. However, methodological limitations of previous studies may limit their generalisability. The present study attempted to address these limitations. We examined associations between childhood physical, sexual, and emotional abuse and several dimensions of adult religiosity in a large sample of college students (N = 763). Associations between child maltreatment and religiosity were weak (rs ≤ 0.09). After controlling for possible demographic confounds, the only significant association was between childhood emotional abuse and religious questing.     

Are Religiosity and Spirituality Associated with Obesity Among African Americans in the Southeastern United States (the Jackson Heart Study)?

There are several lines of evidence that suggest religiosity and spirituality are protective factors for both physical and mental health, but the association with obesity is less clear. This study examined the associations between dimensions of religiosity and spirituality (religious attendance, daily spirituality, and private prayer), health behaviors and weight among African Americans in central Mississippi. Jackson Heart Study participants with complete data on religious attendance, private prayer, daily spirituality, caloric intake, physical activity, depression, and social support (n = 2,378) were included. Height, weight, and waist circumference were measured. We observed no significant association between religiosity, spirituality, and weight. The relationship between religiosity/spirituality and obesity was not moderated by demographic variables, psychosocial variables, or health behaviors. However, greater religiosity and spirituality were related to lower energy intake, less alcohol use, and less likelihood of lifetime smoking. Although religious participation and spirituality were not cross-sectionally related to weight among African Americans, religiosity and spirituality might promote certain health behaviors. The association between religion and spirituality and weight gain deserves further investigation in studies with a longitudinal study design.