McGowan Columbia 0054D 10574
McGowan Columbia 0054D 10574
McGowan Columbia 0054D 10574
PSYCHOLOGICAL DISTRESS
Joseph C. McGowan
2012
2
© 2012
Joseph C. McGowan
ABSTRACT
Joseph C. McGowan
This study explored how the relationship between religiousness and psychological
distress varies by religious affiliation (Christian or Jewish) and by gender. Analyses were
conducted on data collected during interviews with 143 community dwelling older adults
organizational and intrinsic religiosity. Resources including physical health, social support, and
personal efficacy were included as control variables. The dependent variables were symptoms of
depression and anxiety. Supplemental analysis examined clinically significant depression and
anxiety.
gender, education, physical health, social support, personal efficacy, depression, and anxiety.
Hierarchical regression analyses were then conducted in which the independent and control
variables were entered in three steps: (1) demographics (gender, religious affiliation, education),
(2) resources (physical health, social support, personal efficacy), and (3) religiosity and
interaction terms.
Christians were found to be more intrinsically religious than Jews but not more
organizationally religious. Jews displayed a higher risk for clinical anxiety than Christians and
women displayed a higher rate of depression and anxiety symptoms and higher risk for clinical
depression and anxiety than did men. Contrary to predictions, higher levels of organizational
religiosity were associated with a higher rate of anxiety symptoms. Religious affiliation and
4
associated with depressive symptoms and clinical depression to a greater extent for Jews than for
Christians. In addition, gender and religiousness interacted in association with anxiety. Lower
organizational religiosity was associated with anxiety symptoms to greater extent for women
than for men. On the whole, Christians displayed less depression and anxiety at higher levels of
religiousness than did Jews, underscoring the complex relationships among religion,
religiousness, and mental health in late life. This study also provides evidence that women in late
life without religious resources may be more vulnerable to mental illness than their male
counterparts. However, no reliable relationship has of yet been established among gender,
TABLE OF CONTENTS
ACKNOWLEDGEMENTS ........................................................................................................... vi
Participants .................................................................................................................................34
Measures .....................................................................................................................................34
Organizational Religiosity .....................................................................................................34
Intrinsic Religiosity ................................................................................................................35
Psychological Distress ............................................................................................................35
Physical Health ......................................................................................................................37
Social Support ........................................................................................................................37
Personal Mastery ....................................................................................................................38
i
ii
Procedures ..................................................................................................................................38
Data Analysis .............................................................................................................................40
REFERENCES ..............................................................................................................................99
APPENDICES .............................................................................................................................115
A. Demographic Questionnaire ..........................................................................................115
B. Organizational Religiosity Scale ...................................................................................117
C. Intrinsic Religiosity Scale ..............................................................................................118
D. Brief Symptom Inventory ..............................................................................................119
E. Perceived Health ............................................................................................................122
F. Social Support Questionnaire–Short Form ...................................................................123
G. Belief in Personal Mastery ............................................................................................125
H. Acknowledgement and Consent ....................................................................................126
I. Perceived Financial Adequacy ........................................................................................127
iii
iv
LIST OF TABLES
Table 2 Mean, Standard Deviation, Range, and Cronbach’s Alpha for Study Variables ....43
Table 4 Mean, Standard Deviation, Range, and Cronbach’s Alpha by Gender ...................45
Table 7 Linear Regression Predicting Intrinsic Religiosity from Religious Affiliation and
Gender .....................................................................................................................51
Table 12 Logistic Regression Predicting Clinical Anxiety from Organizational and Intrinsic
Religiosity ...............................................................................................................63
iv
v
LIST OF FIGURES
Figure 3 Relationship between Organizational Religiosity and Risk for Clinical Depression
by Religious Affiliation ...........................................................................................66
v
vi
ACKNOWLEDGEMENTS
This dissertation could not have been completed without the support of several people,
research questions with personal meaning and has been instrumental in sparking my interest in
this dissertation’s topic: religiousness and mental health. Through the conception and completion
of this project, Professor Midlarsky always expressed her confidence in me and my work. I am
I am also indebted to Professor Ada Mui, who served as my second reader. Professor Mui
and discussion. Equally important were her optimism and encouragement—apparent at every
stage of this project—which always left me likewise enthused. I would also like to thank
regarding the statistical analyses made this dissertation notably stronger. I also benefited from
the insightful recommendations of Professors Barbara Simon and Marie Miville, which helped
I am especially grateful for my parents, Nancy and Joe McGowan. Not only have they
provided me with innumerable opportunities, but also with the love and support that have been
dissertation and generously lent their time—often caring for my daughter, Neila—as I worked
toward its completion. I would like to thank my wife, Crystal, who remained supportive through
the many nights and weekends that I sacrificed to this dissertation’s completion. She never failed
vi
vii
research. Her love adds so much meaning to this accomplishment. And thank you to Neila, who
J.C.M.
vii
1
Chapter I
INTRODUCTION
This study explores the relationship between religiousness and psychological distress
among older adults (adults aged 65 years and older) and how this relationship varies by religious
affiliation (Christian or Jewish) and gender. Religiosity refers to a type of religiousness which is
often seen as including several distinct facets (e.g., organizational, intrinsic, subjective). On the
other hand, religiousness refers to the individual’s degree of religious devotion. Throughout this
multifaceted in nature, while religiousness is used to refer to the level of commitment to one’s
This study focuses on a rapidly growing group of Americans in need of mental health
support: older adults. Research has shown that older adults tend to be highly religious (Dillon &
Wink, 2007), and that religion often serves as a powerful coping resource for older adults to deal
with late life challenges such as the loss of physical vitality and the death of family members,
spouses, and friends (Harrison, Koenig, Hays, Eme-Akwari, & Pargament, 2001). Few studies,
however, have explored how differences in religious affiliation and gender influence the
association between religiousness and mental health in late life. This study seeks to fill this gap
and further our understanding of the interplay among religiousness, religion, mental health, and
Religiousness has repeatedly been shown to have a positive association with mental
health; people higher in religiousness report lower levels of psychological distress and greater
life-satisfaction (Moreira-Almedia, Neto, & Koenig, 2006). However, prior studies establishing
2
the positive link between religiousness and mental health have used primarily Christian samples
(Koenig, McCullough, & Larson, 2001). The limited work that has been done suggests that
different dimensions of religiousness are associated with improved well-being for Christians and
Jews. Cohen (2002) found that increased public religious practices, such as attendance at
services, were associated with greater life satisfaction among Jews, Catholics, and Protestants.
However, religious coping (reliance on God in dealing with life problems) and religious belief
(belief in God and the afterlife) were associated with increased happiness and quality of life for
Catholics and Protestants, but not for Jews. Likewise, spirituality (sense of inner peace, closeness
to God and creation) was strongly associated with increased happiness and quality of life for
Christians, but less so for Jews. This finding may reflect fundamental religious differences,
including the emphasis in Christianity on a personal relationship with God and belief, in contrast
to Judaism’s emphasis on religious practices and custom. This study explores these differences
using two dimensions of religiosity (organizational and intrinsic) and their differential
A second area of inquiry in this paper focuses on possible variations in the relationship
between religiosity and mental health by gender. Throughout the lifespan, women have been
found to be more religious than men (Francis, 1997). However, women higher in religiousness
do not necessarily display better mental health than men (Krause, Ellison, & Marcum, 2002). In
fact, recent research has indicated that higher religiousness is associated with lower depression
for older men but not older women (McFarland, 2009). It has been suggested that higher levels
of religious activity among older women may exact a cost on their health because maintaining
social relationships with members of religious congregations requires significant effort and
energy. On the other hand, newly retired older men may be better able to exploit the opportunity
3
to hold offices or other leadership positions in their churches or synagogues. This study explores
these differences using two dimensions of religiosity (organizational and intrinsic) and their
differential association with depression and anxiety among older men and women.
This study may have implications for clinicians working with Christian and Jewish older
adults of both sexes. More specifically, while religious behavior may on the whole be associated
with improved mental health, this study may elucidate the specific dimensions of religiosity that
are associated with the lower symptomatology for these two religious groups and for women as
compared to men. This knowledge may assist older adults in finding healthier ways of
Chapter II
LITERATURE REVIEW
The number of older adults in the United States is growing. Projections suggest that
the number of adults over 65 will swell from 12.6% of the United States population today to
18.5% by the year 2025. It is estimated that by 2050, older adults will comprise over 20% of the
population (U.S. Bureau of the Census, 2000). Because older adults constitute a rapidly growing
segment of the population, understanding the unique psychological challenges of late life is vital
Aging has been tied to loss of control (Mirowsky, 1995) and a decline in mental health.
For instance, aging is associated with increased levels of depression and anxiety (Cole &
Dendukuri, 2003; Flint, 1994; Mirowsky & Reynolds, 2000). It is estimated that between 8 and
20% of community dwelling older adults and between 17 and 35% of primary care patients
suffer from depression (Gurland, Cross, & Katz, 1996). On the whole, 12-30% of community
dwelling older adults met criteria for a psychiatric disorder within the last year (Kessler, Demler,
the factors which promote psychological well-being is also important. One factor closely
Eighty-eight percent of adults over 65 report that they believe in God while another 8%
believe in a Higher Power (Gallup Poll, 2008). Religious adherence and participation become
increasingly important as people age (Dillon & Wink, 2007; Koenig, Smiley, & Gonzalez, 1988;
Levin, Taylor, & Chatters, 1995). The Pew Survey (2008) indicated that 50% of all Protestants
5
and Jews are over 50 years old, revealing that these groups are older on average than the rest of
the population (Only 41% of the national total is over 50). In a 2010 Pew Survey, 57% of older
adults born before 1928 reported that they had a strong religious affiliation. Among those born
between 1928 and 1945 this number dipped to 50%, and finally to 43% of those born between
In addition to being highly religiously affiliated, older adults frequently attend religious
services. 53% of adults 65 and over attend religious services regularly. Likewise, older adults
display frequent religious activity outside of formal religious services. For instance, 68% of
How are we to understand the salience of religion in older adulthood? Religion may fill
an existential gap and may provide a framework for understanding the world, human suffering,
and death. Although Freud (1959) described God as a projection of humans’ fears and wishes, he
also acknowledged that religious people were protected against many forms of neurosis. While
increased sense of control and mastery, it has been argued that these belief systems have not
satisfied the human need for comfort and meaning (Baumeister, 1991).
Older adults are presented with specific life challenges which may account for the
increased salience of religion in late life. Erikson (1959) suggested that the primary task of older
adulthood is the development of a meaningful life narrative. Older adulthood is viewed as a time
of reflection and consolidation which ideally culminates in a sense of purpose. Erikson believed
that religion provides a valuable framework for understanding one’s life and resolving
inconsistencies or regrets.
6
Older adults must also confront their physical decline and mortality, and cope with the
loss of roles associated with employment and parenting, of friends, relatives, and spouses
through death. As physical health declines, day-to-day difficulties with self-care become
prominent. Numerous studies have reported an association between functional impairment and
depression (e.g., Pennix, Leveille, Ferucci, van Eijk, & Guralink, 1999). Along with physical
decline comes an increased recognition of mortality. Batson, Schoenrade, and Ventis (1993),
note that older adults no longer consider death an event which will take place in the distant future.
Death is real. The end of one’s life is made even more salient by the death of friends and loved
The high rate of religiousness in older adults suggests that religion serves an important
purpose in their lives. Numerous researchers have noted that religion can be especially helpful in
coping with life’s difficulties (for reviews, see Ano & Vasconcelles, 2005; Harrison et al, 2001).
Pargament (1997) has suggested that people tend to turn to religion when it is available to them
and when human resources have been exhausted. However, research has shown that engaging
religion when in need can have both positive and negative outcomes for mental health. Using
religion in a positive way (e.g., praying to God for support) is associated with positive mental
health, while using religion in a negative way (e.g., feeling as if God has punished one or that the
Devil has possessed one) is associated with worse mental health outcomes. Further, higher levels
of religiousness have been associated with negative attitudes such as authoritarianism and
Early exploration of the relationship between religion and health focused on differences
Associations between religious affiliation and health allowed for speculation regarding the
benefit of certain religious practices. Yet, religious affiliation does not capture dedication to
one’s religion. Moreira-Almedia, Neto, and Koenig note that research exploring the relationship
between religion and health has yielded more robust effects when it assessed the relationship
religiousness (Levin & Vanderpool, 1989). Unlike religious affiliation, which can only capture
group differences, religious attendance can provide an index of religious involvement. Studies
that employed measures of religious activity yielded stronger associations between religiousness
and mental health (See Levin & Vanderpool, 1987 for a review). Much of the prior research,
however, is epidemiological and measures religious attendance using only a single item.
Additionally, religious attendance has typically been studied in relationship to physical health
rather than mental health—increased attendance is associated with better physical health and less
health risk.
Although quantifying religious attendance was an improvement, it did not capture the
highly nuanced nature of religiousness. Allport (1954) was the first to develop a
one’s personal faith and devotion, while extrinsic religiosity refers to behaviors and activities
such as prayer and attending services. In his discussion, Allport frames extrinsic religiosity as
self-serving and suggested that it was completed with the goal of improving one’s status in the
Mindel and Vaughn (1978) distinguished between religious behaviors completed under
the imprimatur of the formal religious authority and activities completed independently. The
8
Subsequent factor analysis supported this distinction (Krause & Tran, 1989). Chatters, Levin,
and Taylor (1992) later refined this construct. Subjective religiosity was shown to be associated
religiosity (Levin, Taylor, & Chatters, 1995). The resulting scale yields organizational and
Levin, Taylor, and Chatters did much to increase the complexity of religiosity measures,
which allowed for a more complete picture of the relationship between religiousness and mental
health. However, previous work from our lab (Gregory, 2001) has noted that even
religiosity assess behavior, while subjective religiosity refers to the importance of religion in
one’s family and one’s life. More specifically, the Subjective Religiosity Scale captures (1) how
religious one feels, (2) how important religion was in one’s household growing up, and (3) the
unclear whether the determination of religious importance is based upon behavior, a deep
connection with the Divine, or the ubiquity of religion in one’s life and decision making.
Researchers may have turned away from the assessment of religious motivation due to
Allport’s pejorative framing of external religious expression and behavior. Allport and Ross
(1967) developed the Intrinsic and Extrinsic Religiosity Scale and found that people higher in
9
extrinsic religiosity displayed a greater incidence of prejudice. Their efforts can be placed within
the context of the post-World War II emphasis on the potential links between religion and
Hoge (1972) noted that the distinction between extrinsic and intrinsic religiosity could be
further refined, noting Allport’s emphasis on religious motivation. The resulting scale included
10 items capturing intrinsic religious motivation—the degree to which an individual lives his or
her religion, religion restricts behavior, and influences secular decision making. A database
search revealed that Hoge’s Intrinsic Religious Motivation Scale was cited 290 times in the
nearly 30 years since its development, and it remains widely used in contemporary research. In
1997, Koenig, Parkerson, and Meador adapted Hoge’s intrinsic religiosity scale for a 5-item
multidimensional scale of religiousness. The resulting scale (The Duke Religion Scale) consisted
and 2 items capturing intrinsic religiosity. These three constructs are presented as representing
the three major dimensions of religiosity (Koenig & Futterman, 1995). Other scales have further
expanded the notion of religious motivation—as in “closeness to God” (e.g., The Spiritual
Support scale; Maton, 1989). However, an examination of these measures is beyond the scope of
Psychology and psychiatry have been slow to embrace the study of religion or to
recognize that religion is related to mental health (Moreira-Almedia, Neto, & Koenig, 2006).
Seminal thinkers in the psychological sciences such as Freud, Jung, and James displayed
significant interest in the complex relationships among religion, spirituality, and psychological
well-being. However, while recent scholarship has suggested that Freud was more ambivalent
10
about religion than many of his writings suggest (Vitz, 1993), his official position had a deep and
long-lasting resonance among the psychoanalytic and psychological community. Freud wrote
that God was a manifestation humans’ need for security; a projection of the desire for protection
by a father figure which facilitated the transition from childhood to adulthood (Freud, 1927).
Early psychoanalytic theory and practice might be said to have, at best, neglected religion and at
worst framed religious belief as pathological. Positivistic and naturalistic perspectives came thus
to dominate mental health throughout the 20th century, and religiousness and spirituality were
viewed as immaterial and therefore beyond the scope of scientific inquiry. Those few researchers
who were interested in religion typically “buried religious variables in the methods and results
sections” (Miller & Thoresen, 2003, p. 26) and tended not to emphasize such findings in
The emergence of Rogerian humanistic values in the 1950s and 1960s shifted away from
the psychoanalytic enmity toward religion but remained relatively indifferent to God and the
potential benefits of religiousness. Others remained unconvinced. Albert Ellis, for instance,
continued to suggest that religion was deleterious to mental health because it encouraged
passivity and inhibition. Ellis asserted that religion reinforced irrational thinking which
artificially increased well-being but in the long term resulted in emotional disturbance.
Structured religious belief systems do not encourage the expressiveness and flexibility that Ellis
believed necessary for optimal psychological health. As a result, Ellis believed that the less
religious someone was, the better his or her mental health would be (Ellis, 1987). Wendell
Waters (1992) likewise suggested that religiousness may lead to low self-esteem, depression, and
sometimes to psychosis. On the whole, however, the mental health field came to view religion
11
more favorably in the 1970s and 1980s as scholars recognized the psychological benefits of
Roughly 50 years after Freud’s death, then, the focus on religiousness returned in a flurry
of research in the 1980s and 1990s. The relationship between religiousness and improved mental
health is now well documented, despite some studies revealing no association between them
(Courtenay, Poon, Martin, Clayton, & Johnson, 1992; Koenig, Ford, George, Blazer, & Meador,
1993). In their 2006 meta-analysis, Moreira-Almedia, Neto, and Koenig reported that over two-
thirds of the 850 articles that they reviewed revealed a positive association between religiousness
religiosity and mental health. Religious attendance has been inversely associated with depression
in many studies (Bosworth, Park, McQuiod, Hays, & Steffens, 2003; Braam, Beekman, Deeg, &
van Tilburg, 2001; Koenig, Hays, George, Blazer, Larson et al, 1997; Meertens, Scheepers, &
Tax, 2003; Milstein, Bruce, Gargon, Brown, Raue, et al, 2003; Pressman, Lyons, & Larson,
1990).
religiosity effects positive changes in mental health. Koenig, McCullough, and Larson (2001)
suggest that religiosity may positively influence mental health through spiritual, social, and
intellectual avenues. Ellison et al (2009) note that religious services bring together like-minded
groups of people. Collective participation in the religious community’s sacred rituals may
educational characteristics. Such similarities increase the likelihood that meaningful friendships
can be developed. The regularity of religious services further strengthens these bonds, as does
the tendency of many adults to remain in the same church, parish, or synagogue for many years
at a time. Such relationships may also extend outside of the formal service to other sanctioned
events and groups (e.g., volunteering at a church shelter or membership in The Knights of
Columbus; Bradley, 1995; Ellison & George, 1994). Colucci and Martin (2008) showed that
religious involvement is associated with decreased risk of suicide and suggest that this
relationship is due to increased social integration. Similarly, Ferraro and Kelley-Moore (2000)
indicate that the more socially integrated individuals are into their religious community, the more
likely they are to ask for help when such help is needed.
programs to assist those in distress (Trinitapoli, 2005), members of those institutions are likely to
aid others in need. Prior work has shown that attendees at religious services readily assist other
members by providing material goods and emotional support, knowing that they will also receive
aid in their time of need (Ellison & George, 1994; Krause, 2002). Krause (2008) showed that
perceiving that emotional support was available among older churchgoing adults was closely tied
explicitly encourage healthy behavior and lifestyles (Hill, Ellison, Burdette, & Musick, 2007).
codes that prohibit excessive drinking, and prior research indicates that there is a negative
association between religious service attendance and drinking (Hill & McCullough, 2007;
13
Koenig, George, Meador, Blazer, & Ford, 1994). Religiousness has also been associated with
safer sexual practices and monogamy (See Koenig, 2001 for a review) as well as a lower
Intrinsic religiosity has also been associated with improved mental health. In a sample
of older adults hospitalized due to medical illness, Koenig, George, and Peterson (1998) found
that those higher in intrinsic religiosity displayed a more rapid remission of depression than did
those low in intrinsic religiosity. Kendler, Gardner, and Prescott (1997) found that personal
devotion, which captures both intrinsic and nonorganizational religiosity (e.g., consciousness of
religious purpose, frequency of seeking spiritual comfort, and frequency of private prayer), was
associated with a decreased incidence of depression. Fehring, Miller, and Shaw (1997) found a
positive association between intrinsic religiosity and both increased hope and positive mood
states in a sample of older adults with cancer diagnoses. A negative relationship was also
indicated between intrinsic religiosity and depression as well as other negative mood states such
as depression.
While intrinsic religiosity is closely tied to religious service attendance and private prayer,
these behaviors do not capture the degree to which religion guides an individual’s decisions and
behavior. Allport (1959) notes that individuals high in intrinsic religiosity “live” their religion,
which affords them increased purpose and meaning. Intrinsic religiosity may positively influence
mental and physical health outcomes because it allows older adults to transcend poor health or
other difficulties, drawing their self-esteem and purpose from their faith instead. While physical
health decline may result in the loss of certain activities, the religious beliefs, traditions, and
purpose of older adults may remain unchanged. Such a view may cultivate optimism which
facilitates positive mental health outcomes (Koenig, George, & Peterson, 1998).
14
Prior research suggests that Jews tend to display a higher incidence of depression than
Christians do in both clinical and community samples (See McCullough & Larson, 1999 for a
review). On the other hand, Christians display higher rates of alcoholism (Levav, Kohn, Golding,
& Weissman, 1997). Many Jewish groups tend to discourage the use of alcohol. As a result, Jews
with latent psychopathology may tend to express mental illness in the form of depressive or
anxiety symptoms. Another possibility is that Jewish people, especially those of Eastern
European descent, may be more willing to disclose negative emotions (Glicksman, 1991).
Previous work has shown that Jews are more stigma tolerant and have more favorable attitudes
towards psychotherapy than do Christians (McGowan & Midlarsky, in press). Nevertheless, the
consistency with which prior research has demonstrated elevated rates of affective disorders
among Jews as opposed to Christians suggests that fundamental differences between these
Because prior research has shown that Jews often display higher rates of depression than
with mental health. While a large amount of research suggests a positive association between
increased religiousness and mental health, studies have largely consisted of Christian samples
(Koenig et al., 2001). Limiting this study to Caucasian participants offers a unique opportunity to
examine the relationship between religiousness and psychological distress among a sample
Cohen (2002) suggests that core differences between Christianity and Judaism may be
responsible for the association of certain dimensions of religiosity with better mental health
15
among members of one group but not the other. One fundamental distinction between these two
religions concerns the nature of membership. According to Morris (1996), assent religions rely
on members’ shared adherence to common theology, truths, and values. On the other hand,
descent religions pass membership from one person to another biologically. Christianity is
therefore an assent religion, while Judaism is a descent religion, lending it an ethnic membership
component (Neusner, 1993). While Jewish theologians such as Maimonides offered principles of
faith that include a belief in a God who lacks physical presence, it is not clear how one adheres to
them in Judaism. Cohen and Koenig (2003) note that because rabbinical scholars such as
Maimonides (1967) have traditionally taught that the true nature of God cannot be known and
that there is no “personal” relationship with God as there is Christianity, significant individual
variations in belief are acceptable. Because adherence to such beliefs is not vital to Jewish
peoplehood a wide range of beliefs about God are viewed as acceptable by Jews (Ariel, 1995).
Such a contrast leads to important differences in the practices of Christians and Jews
(Cohen, 2002). The emphasis on belief in Christian tradition necessitates the cultivation of a
personal relationship with God or other religious figures such as the Virgin Mary as in
Catholicism. Faith in the Divine is cultivated through individual spiritual practices and private
prayer in addition to attendance at formal religious services. A personal relationship with God
allows one to achieve salvation and entrance into the Kingdom of God in the Afterlife. For
Catholics, a personal relationship with God is mediated through the church while in
Protestantism, each person is responsible for the development of their individual connection with
the Divine. Adherence to belief for Christians is of vital importance not only in determining
membership, but also in preparing for the Hereafter. In contrast, religious adherence in Judaism
is measured by the degree of observance of halakha, or law, the individual’s relationship with
16
the Jewish community, and compassion for others. Belief in God is assumed but not required.
While Christianity emphasizes a personal relationship with God, self-sacrifice, and salvation,
Judaism emphasizes compassion and bringing goodness into the world (Zedek, 1998). It has
been noted that perhaps the most salient distinction between Christianity and Judaism concerns
the emphasis on the cultivation of internal states among Christians and on religious behavior by
Jews (Prager & Telushkin, 1981). Jewish law, especially as implemented by Orthodox Jews,
provides hundreds of rules that govern the individual’s daily life and relationships. While some
Christians traditions provide close rules for members—Catholicism and Evangelism provide
Empirical work supports this distinction. Among Jews, degree of religiousness tends to
the other hand, evaluate their level of religiosity based on not only adherence to religious rituals
and church attendance, but also on belief in Protestant teachings (Cohen, Siegel, & Rozin, 2003).
There is also evidence that Protestants consider internal states an important aspect of
religiousness while Jews do not. More specifically, Cohen and Rozin (2001) discovered that
Protestants were much more concerned about the moral consequences of thoughts than were
Jews.
In the only known empirical study exploring the relationship of religiosity to well-being
among Jews, Catholics, and Protestants, Cohen (2002) found that religious belief, spirituality,
and coping by turning to God were strongly associated with life satisfaction and happiness for
Catholics and Protestants but not for Jews. However, all three groups displayed a strong
association between increased congregational support and higher life satisfaction. Cohen’s paper
17
consisted of three separate studies. In the first, participants were 2,279 adults, consisting of 1524
Protestants, 705 Catholics, and 50 Jews. Religiousness was assessed using ad hoc measures
capturing congregational support (2 items), religious belief (2 items), spirituality (6 items; e.g.,
desire to be closer to God; feeling deep inner peace or harmony), reliance on God in dealing with
problems (4 items), and public religious practice (2 items). Happiness was measured using a
single item on a 4-point scale, with 1 reflecting “very happy” and 4 reflecting “not happy at all.”
Catholics and Protestants displayed higher levels of religious belief, spirituality, and tendency to
turn to God for help than Jews. Correlational analyses revealed significant associations between
spirituality and reliance on God and happiness for Catholics and Protestants but not Jews. The
authors note, however, that the small number of Jews in this study as well as few degrees of
A second study was then conducted to replicate the first study but this time including a
larger number of Jewish participants. The Internet was used to recruit a total of 309 adult
participants including 94 Catholics, 95 Jews, and 120 Protestants. Measures of religiosity were
consistent with the first study; however, life satisfaction rather than happiness was used as the
dependent measure. Life Satisfaction, which captures global view of one’s life in contrast to
happiness which captures a more transitory state, was assessed using the Satisfaction with Life
Scale (SWLS; Pavot & Diener, 1993) and the Delighted-Terrible Scale (DT; Andrews &
Robinson, 1991). Neuroticism, Optimism, and Pessimism were also included in this study as
controls. Catholics and Protestants displayed higher levels of belief, spirituality, and coping with
problems by turning to God than did Jews. Catholics, Protestants, and Jews displayed
comparable levels of public religious practice. Regression analyses were conducted which
included demographics (sex, age, education), personality traits (neuroticism, optimism, and
18
pessimism), and religiosity (public practice, turning to God for help/coping, congregational
support, belief, and spirituality). For Catholics, public practice was significantly related to the
SWLS scale, and public practice and spirituality were significantly associated with the DT scale.
For Protestants, religious belief and spirituality were significantly related to the SWLS scale, and
spirituality was significantly related to the DT scale. For Jews, public practice and
congregational support were associated with the SWLS scale, while none of the religiosity
Cohen’s (2002) third study explores the same questions as studies one and two, this time
using a sample of Protestant and Catholic college students ranging in age from 17 to 23. The
college from which the sample was drawn did not have a significant number of Jewish students.
The sample of consisted of 163 participants (96 Protestants and 67 Catholics). Happiness was
assessed using a single item where – 7 reflected completely unhappy and + 7 reflected
completely happy. Life satisfaction was again assessed using the SWLS scale. Religiosity scales
were expanded in this third study, though measures of congregational support, spirituality, and
religious coping were comparable to the first two studies. Two items were added to capture
religious identity (e.g., “How important a part of your identity is your religion or faith for you?”).
Expanded measures of Christian religious belief (15 items), practice (16 items), and knowledge
(17 items) were added following Cohen, Siegel, and Rozin (2003). These measures were
developed using a Protestant sample and no additional items were added due to the presence of
Catholics in this current sample. Catholic and Protestant students displayed comparable levels of
religious identity, spirituality, religious practice, religious belief, and religious coping, while
Protestants displayed slightly higher degrees of congregational support and religious knowledge.
Regression analyses revealed that religious identity, congregational support, and spirituality all
19
made unique contributions to SWLS. In terms of happiness, only coping through turning to God
made a significant contribution for Catholics. For Protestants, only spirituality made a unique
While this work provides important insight into the relationship among religious
affiliation, religiousness, and well-being, no known study has yet explored how the relationship
between these differing dimensions of religiosity and psychological distress may vary between
Christians and Jews. This paper will therefore seek to fill this gap, exploring the association
between organizational and intrinsic religiosity and depression and anxiety among older adult
When traveling in France my father noticed a line of cars in front of a Catholic cathedral.
When he looked more closely, he observed that men were dropping their wives off for Sunday
mass and then driving away, presumably to return afterward to pick them up after the service.
Scenes of this kind are not uncommon, and gender differences in religiousness across the
lifespan are well documented; in research studies with women of all ages, women tend to be both
more organizationally and intrinsically religious than are men (See Francis, 1997 for a review;
Milevsky & Levitt, 2004). The expectation of gender differences in religiosity is so pervasive
of gender differences in religiosity have been noted among early Greek, Roman, and Christian
writers. For instance, Greek writers noted that women were more likely to be persuaded to join
new religions or cults (Stark, 2002, citing Beard, North, & Price, 1998). Likewise, some have
suggested that early Christian converts were also more likely to be women (Stark, 1996). Recent
polls confirm this difference. For instance, in a 2002 Gallup Poll, 68% of women reported that
20
religion was very important to them compared to 48% of men. Likewise, 69% of women
The reasons for gender differences in religiosity continue to stimulate lively debates
(Ellison, Finch, Ryan, & Salinas, 2009). Higher levels of religiosity in women may have origins
in gender norms and social roles that are reinforced from a young age. Young girls are typically
taught to be sociable, friendly, deferent, and to engage in caretaking tasks such as looking after
younger siblings or helping with meal preparation. On the other hand, boys are socialized to be
assertive and autonomous. They are often afforded more freedom from a younger age which
allows them to take on tasks outside the home such as a paper-route. Idler (1987) noted that
gender socialization restricts the scope of females’ relational opportunities, and religious
contexts are among the few places in which women are encouraged to interact with others.
Because women often take a more active role in childcare, they may also be responsible for the
religious education of the children, which leads them to spend more time at religious services,
rituals, and social functions. Koenig (1994) similarly suggests that religion is more important to
older women because of their lower social status. Religious participation allows them to
participate in an institution that may increase their esteem and stature. Likewise, Beit-Hallahmi
and Argyle (1997) have noted that female traits such as nurturance, compassion, and deference to
authority are highly important in religious settings. Religious participation may be appealing to
Miller and Hoffman (1995) suggested that women tend to be more religious because
religion is averse to risk, and risk aversion is consistent with female socialization and deference.
The authors note that religion provides a risk management strategy for dealing with existential
questions such as the fear of death, desire for control, and need for comfort in times of difficulty.
21
Subsequently, Miller and Stark (2002) offered further empirical support for this explanation,
noting that women may be more religious than men because in some traditions it is theologically
risky to be irreligious. Theologically, Catholic priest and philosopher Blaise Pascal (1623-1662)
noted that there is no harm believing in God, while the potential consequences of not believing
are substantial. If one believes in God and He exists, then the reward is eternal life, and if one
believes in God and He does not exist, then there is no harm done. However, if one does not
believe in God and He does exist, then the consequence is damnation. This theological bet
became known as “Pascal’s wager” (Durkin & Greely, 1991). The possibility of posthumous
punishment is omnipresent among Western religions including Christianity, Islam, and Orthodox
Judaism, while Reform and Conservative Judaism do not ascribe to a specific belief in the
Physiological explanations have also been offered to explain higher degrees of religiosity
among women. Stark (2002) notes the growing body of work indicating a physiological
underpinning to gender differences in crime. Men, especially young men, tend to be impulsive;
they display risky behaviors such as driving without a seatbelt or while intoxicated, and
gambling compulsively (Gottfredson & Hirschi, 1990). As noted above, religious communities
often promote healthy behaviors and prohibit risky behavior such as promiscuity or excessive
drinking. Increased religiousness in women may reflect a biological desire for security, while
men’s lesser religious adherence may suggest that they participate in behavior inconsistent with
religious law. Stark (2002) notes that criminology and the social scientific study of religion
overlap on the same set of proscribed behaviors. Physiological differences between men and
women such as testosterone levels have been shown to be associated with antisocial behavior
(Dabbs & Morris, 1990). No work, however, has yet explored the direct association between
22
While there is strong evidence that women are more religious than men, increased
religiousness is not always linked to higher rates of mental health (Krause, Ellison, & Marcum,
2002). Ellison et al (2009) note that this may be the reason that meaningful gender x religiosity
interactions are seldom reported in the research literature. That is, while women consistently
report higher levels of religiousness than do men, they do not report better mental health.
Indeed, women typically report higher rates of depression and anxiety than do men
(Leach, Christensen, Mackinnon, Windsor, & Butterworth, 2008; Piccinelli & Wilkinson, 2000;
Prince et al., 1999; Silverstein, 1999). Gove (1984) argues that gender differences in
psychological distress are rooted in the different social roles which men and women tend to
adopt. Men tend to occupy fixed roles which are highly structured and associated with higher
esteem and better mental health. On the other hand, women tend to occupy nurturant roles which
often strain their personal resources and impair their ability to cope with distress. Further, in
times of distress it may be difficult for female caregivers to adopt a sick role themselves which
Other researchers have suggested that personality factors are responsible for gender
differences in depression. In an adult sample, Goodwin and Gotlib (2004) found that neuroticism
in part accounted for the relationship between gender and depression, though this association
remained even when neuroticism was controlled for. Leach et al. (2008) explored potential
personality and psychosocial mediators of the relationship between gender and depression and
anxiety in three age cohorts: 20-24, 40-44, and 60-64. Among the shared mediators for all age
groups of both depression and anxiety was childhood adversity, mastery, behavioral inhibition,
23
neuroticism, ruminative style, physical health, physical activity, and perceived interpersonal
problems.
Two competing perspectives have been offered to explain how gender influences the
relationship between religiousness and mental health (McFarland, 2009). The first suggests that
women derive more benefit from religiousness because they are more open to the social
networks and support that accompany religious membership. The second framework argues that
men gain more benefit from religiousness because religion creates a unique context within which
they can ask for help. Additionally, this framework suggests that because men are more likely
than women to take on leadership roles and positions of authority in their church or synagogue,
religiousness may elevate their self-esteem. These competing perspectives and the empirical
The first framework suggests that women derive a greater mental health benefit from
religiosity than men because women tend to form more social relationships in religious contexts
than do men. Characteristics often associated with femininity such as nurturance and strong
interpersonal communication may allow women to quickly develop and maintain friendships.
Because women often comprise the majority of religious groups, female members have access to
a large number of peers with whom they share a great deal in common. Furthermore, the frequent
sharing of problems among groups of religious women may lead certain members to become
quite knowledgeable about certain issues and adept at giving advice (Wuthnow, 1994).
A limited number of studies have explored variations in the relationship between intrinsic
religiosity and mental health by gender. In a sample of 318 Catholic undergraduate and graduate
students, Templin and Martin (1999) found that men and women did not differ in their degree of
24
intrinsic religiosity. However, increased intrinsic religiosity was associated with less frequent
drinking and fewer drinking related problems for females but not for males. The authors suggest
that women may more naturally connect religious beliefs and values with healthy behaviors than
men. Prior research has suggested that intrinsic religiosity may increase an individual’s sense of
purpose and meaning, which leads to better physical and mental health. Cohen, Hall, Koenig,
and Meador (2005) note that intrinsic religiosity appears to be related to the private and
emotional aspects of religion. It is possible that women may better use their emotional
There is also empirical evidence that women extract more mental health benefit from
organizational religiosity than do men. In a sample of 700 Midwestern adults ranging from ages
18 to 55, Mirola (1999) found that women who attended church more frequently and those who
reported higher levels of religiousness displayed less depressive symptomatology. Men did not
display an association between religiousness and depression. The author argues that women’s
higher frequency of attendance places them in a better position to develop and employ social
Hintikka, Koskela, Kontula, and Viinamäki (2000) attained comparable results in a large
epidemiological study in Finland. The sample consisted of 1,975 adults ranging in age from 18 to
74, and mental health was assessed using the General Health Questionnaire (Goldberg &
Williams, 1988) which includes a total of 12 items assessing anxiety, depression, and self-esteem.
Results indicated that women who attended religious services more frequently displayed better
mental health. This association remained when social contact and family support were controlled
for. There was no relationship between religious attendance and mental health among men.
However, the authors note that measuring religiousness using only a single item as was
25
the case in their study limits the conclusions that can be drawn.
Strawbridge, Shema, Cohen, and Kaplan (2001) showed that women tend to reap more
mental health benefits from religious attendance than men over time. A sample of 2,676
participants were first contacted in 1965 (participants ranged in age between 17 and 65 in 1965)
and then subsequently in 1974, 1983, and 1994. In their analyses, religious attendance was
dichotomized, with participants who attended religious services once per week or more in one
group and those who attended less than once per week or not at all, in the other. Mental health
was assessed using the 18-item depression scale developed by Roberts and O’Keefe (1981).
Results indicated that women who attended religious services at least once per week and also
met criteria for depression were more likely to have experienced remission at follow-up than
religious men. Among this study’s limitations, however, is the unidimensional measurement of
religious attendance, which did not capture religious activity outside of formal services or
religious motivation.
Ellison, Finch, Ryan, and Salinas (2009) found that church attendance was associated with lower
rates of depression; however, this effect was no longer significant after controlling for social
support. Religious salience, though, was related to decreased depression in both men and women
independently of controls, but was significantly stronger for women. This study demonstrated
significant interaction effects. The authors note that the greater benefit associated with being a
Mexican-American female may be related to the emphasis on Marian devotion among this group.
Our Lady of Guadalupe is also the patron Saint of Mexico. The cultural emphasis on a female
religious figure may empower Mexican-American women and provide them with validation
Among studies of older adults, only one article was found showing that women attain a
greater psychological benefit from religiousness than men do. Norton, Skoog, Franklin, Corcoran,
Tschanz, Zandi, et al. (2006) explored the relationship among gender, religiousness, and
depression using a sample of 4,468 older adults aged 65 to 100 years. One highly desirable
characteristic of this sample was its homogeneity; all participants lived in Cache County, Utah
and over 90% were members of the Church of Jesus Christ of Latter-Day Saints. Frequency of
attendance at religious services was measured using a single item and depression was measured
using the Diagnostic Interview Schedule (Robins, Helzer, Croughton, & Ratcliff, 1981). There
was an interaction effect between religiosity and gender on depression. Results indicated that
women reporting more frequent church attendance were more likely to report lower levels of
depression. For men, the opposite association was found; more frequent religious attendance was
associated with higher incidence of depression. Both effects remained significant when control
variables were introduced, including demographics, physical health, and social support. The
authors suggest that, like women in other religious groups, female Latter-Day Saints members
build strong social bonds with other members of their church which benefits their mental health.
While The Church of Latter-Day Saints is largely patriarchal in its structure—men hold most
positions of authority—Norton and her colleagues note that such leadership roles are typically
filled by middle-aged men. Older Latter-Day Saints men may experience this lack of inclusion
within the church authority as a significant loss and detrimental to their esteem.
While the homogeneity of this sample may allow for the results to be applied to
comparable groups, it is difficult to generalize these findings to older adults more broadly. The
authors also note that the measure of religiosity—one item assessing religious service
The second framework suggests that men higher in religiousness will receive more
psychological benefits than women higher in religiousness. In a sample of 45 at-risk (e.g., low
socioeconomic status) high school students ranging in age from 14 to 17 years old, Davis, Kerr,
and Robinson (2003) found that intrinsic religiosity was related to lower trait anxiety for boys
but not girls. The authors suggest that females’ high level of trait anxiety may have been the
More convincing though are two other studies that lend support to this position, both of
which use samples of older adults. Idler (1987) found evidence that both men and women higher
in religiousness reap psychological benefits. Both public and private religiosity were assessed in
a sample of 2,756 older adults residing in Connecticut. Public religiousness was measured using
two items, one capturing religious attendance and the other the number of people that the
individual knew within the religious congregation. Private religiousness, in this case, captured
subjective feelings of religious importance. Depression was measured using the Center for
Epidemiological Studies Scale (CES-D). There was an inverse association between increased
public religiosity and lowered depressive symptoms among women and men. However, the
association between public religiousness and decreased depression was stronger for women (p
< .001) than for men (p < .05). Yet men higher in private religiousness also displayed fewer
depressive symptoms than women higher in private religiousness. Idler notes that this finding
may indicate contrasting coping styles; older men may withdraw to seek spiritual support, while
The most compelling study supporting this framework is McFarland’s 2009 paper, which
examines gender differences in the association between religiosity and mental health
longitudinally. The sample included 801 adults aged 65-94 years old and was drawn from
28
throughout the United States. Only Christians were included in this study. Participants were
interviewed in two waves: 2001 and 2004. Organizational religiosity was assessed using three
items capturing frequency of attendance at services, prayer services, and Bible study. Similarly,
nonorganizational religiosity was measured using three items which quantified the frequency of
private prayer, bible study, and loyalty to religious television or radio programs. Depression,
death anxiety, optimism, and self-esteem were each assessed using between three and five items.
For men, higher organizational religiosity was associated with lower depression symptomatology
and higher optimism and self-esteem. This was not true for women. Moderate levels of
organizational religiosity in men were associated with higher death anxiety. For women, both
moderate and higher levels of nonorganizational religiousness were associated with decreased
death anxiety. However, higher levels of organizational religiosity in women were related to
more death anxiety. On the whole, men who more frequently participated in organized religious
McFarland (2009) suggests that older men stand to gain more than older women from a
comparable level of religious involvement. Women are more social and attend service more
often, and yet they tend to be more deferent and occupy more subordinate roles. Heyer-Grey
(2000) found that women are less likely to lead prayers, serve as Eucharistic ministers during
communion, and read from scripture. Older men may thrive in organizations which offer
opportunities for leadership. As they transition from the workforce into retirement, positions of
authority within their church may provide an important source of self-esteem and agency.
Women in contrast are less likely to have worked outside the home (Henretta, 2001). Older
women also tend to maintain broader networks of friends, while men may more unilaterally draw
friendships and support from religious participation. McFarland notes two other relevant areas of
29
research lending support to this position. Krause et al (2002) found that despite maintaining more
relationships and the greater availability of support in their churches for women compared to
men, men still displayed a greater physical health benefit than women. It may be the case that
religious obligations and relationships maintained through religious institutions or events may
lead women to overextend themselves. Women are often responsible for maintaining family
relationships and friendships for both herself and her husband. As a woman’s social network
grows, new additions may lead to little benefit, instead exacting a price on her health and
psychological well-being. Kessler, Price, and Wortman (1985) showed that maintaining large
McFarland speculates that the unique challenges and circumstances of older adulthood
lead the primary mental health benefit to shift from women to men. Men over 65 years of age
tend to be retired and may be in need of activities and organization memberships which increase
their social contact. Men occupy a high number of authority positions within religious
organizations and may derive a significant mental health benefit from this activity, while women
continue in more subordinate positions. Religious activity may be an effective compensation tool
Additionally, while women may have maintained strong ties with their religion
throughout their lives, men may more fully explore and harness their religion in older adulthood.
Consistent with social and biological explanations of gender differences in religiosity, women
may be more naturally drawn to all forms of religiosity; however, while women are on the whole
more religious, men who take advantage of religion may be required to behave in ways to which
they are less accustomed, which leads to more positive life changes. Men must modify their
behavior and their attitudes to a greater degree in order to participate in religious activities,
30
which may result in greater physical and mental health benefits. For instance, men may make
more social contacts, provide support for others, and self-reflect more frequently than before
through service attendance. Some sociological research has suggested that men’s mental health
tends to benefit more from being married than women’s (Williams, 2003) despite the fact that
men often have more reservations about commitment. Therefore, I speculate that like marital
commitment in which men are often required to change more than women (men, for example,
may give up unhealthy habits such as heavy drinking and promiscuity when they marry), so too
Summary
In sum, older adults display high rates of mental illness in part due to life-stage
challenges, including the loss of loved ones and physical vitality. Older adults are highly
religious and there is evidence for the benefits of religious coping on mental health. Specifically,
there is evidence that organizational and intrinsic religiosity benefit mental health, though the
mechanisms of these effects are still in question. However, most work exploring the relationship
between religiosity and mental health has used Christian samples. Jews tend to report higher
dimensions of religiosity are used to determine religious membership and commitment. For
Christians, adherence to ritual and attendance, belief, and a personal relationship with God
indicate degree of religiosity, while for Jews synagogue attendance and ritual adherence alone
appear to indicate level of religiosity. As might be expected, research has shown that adherence
to ritual and service attendance, beliefs, and a personal relationship with God are related to
increased life satisfaction and happiness for Christians. For Jews, on the other hand, it is
31
religious behavior such as synagogue attendance that is associated with higher levels of well-
being.
The association between religiousness and mental health among men versus women also
remains unclear. Research shows that women are more religious than men but women also
display higher rates of mental illness. It has been suggested that women are drawn to religion
more strongly than men because religion is consistent with their social roles as caretakers and
nurturers, while biological perspectives suggest that women are more religious because religion
offers a strategy for existential risk management. Prior work has suggested that women extract
more benefit from religion because of their higher dedication and ability to build social
connections; however, these studies have predominantly employed samples of younger adults.
Recent work has revealed a stronger association between religiosity and better mental health for
older men than for older women. One explanation for this is that men may be better positioned to
take advantage of religion in late life because it fills a void left in the absence of career pursuits.
Men hold more formal positions of authority in churches, synagogues, and religious
organizations, while the roles of women tend to be subordinate. Older men may be drawing a
significant amount of agency and esteem from religious activity leading to stronger associations
between higher levels of religiousness and better mental health among men than women.
who belong to predominantly Black Churches—and White Christians differ significantly in their
expression of religiousness (Jacobson & Heaton, 1990; Levin, Taylor, & Chatters, 1994), and the
inclusion of both White and Black Christians in this sample would introduce a high level of
complexity. Because this study focuses on Christian-Jewish differences, heterogeneity among the
Hypotheses
I. There are religious affiliation differences in levels of intrinsic religiosity but not
organizational religiosity. Christians and Jews will report comparable levels of organizational
religiosity; however, Christians will report higher levels of intrinsic religiosity than Jews.
II. There are gender differences in religiousness. More specifically, women will display
III. There are religious affiliation differences in number of depression and anxiety symptoms.
Specifically, Jews will display a greater number of depression and anxiety symptoms than
Christians.
IV. There are gender differences in number of depression and anxiety symptoms. More
specifically, older women will display a higher number of depression and anxiety symptoms than
older men.
anxiety symptoms. More specifically, older adults higher in organizational and intrinsic
Research Questions
depression and anxiety symptoms similar among Christians and Jews? More specifically, do
Christians display a stronger relationship between intrinsic religiosity and lower number of
II. Is the relationship between religiousness (organizational and intrinsic) and number of
depression and anxiety symptoms similar among men and women? More specifically, do men
33
Chapter III
METHOD
This study will use data that was collected as part of a larger study of older adults
conducted in the metropolitan New York area, entitled Psychotherapy and Counseling with
Older Adults: Predictors and Barriers to Participation. Funding was provided by the AARP
Columbia University.
Participants
Participants for this study included 143 community dwelling older adults, 94 women and
49 men. The sample consisted of Caucasians identifying as either Christian (74; 43 Catholics
and 31 Protestants) or Jewish (69). The mean age was 76.82, with a mode of 80, and a range
from 65 to 94 years of age. At the time of the study, 77 of the sample (53.8%) were widowed,
45 (31.5%) were married, 14 (9.8%) were divorced or separated, and 7 (4.9%) had never been
married. Regarding education, 2 (2.1%) completed elementary school, 83 (58.1%) had some
secondary education or a high school diploma, 26 (18.2%) had some college, and 31 (21.7%) had
an undergraduate degree or had also completed a post-bachelors degree (See Appendix A for
Demographic Questionnaire).
Measures
developed by Chatters, Levin, and Taylor (1992) and consists of 5 items, which assess formal
participation in religious services and other activities. All items include either a “yes-no”
response format or rest on a 5 or 6-point scale. The response choices include, 6 “Nearly Every
Day,” 5 “At Least Once A Week,” 4 “A Few Times A Month,” 3 “A Few Times A Year,” 2
35
“Less Than Once A Year,” and 1 “Never.” A sample item includes “How often do you usually
attend religious services?” The final item is “How much have you held positions or offices in
your church, synagogue, or other place of worship?” with 5 representing “Very Often” and 1
representing “Never.” Chatters, Levin, and Taylor reported statistically significant factor
loadings for each of these items. Factor coefficients ranged from .41 to .78. Cronbach’s alpha for
Intrinsic religiosity. The Intrinsic Religiosity Scale (Hoge, 1972; Appendix C) consists
of 10 items capturing the degree of religious commitment. The first seven items employ a 4-
point scale with 4 reflecting “Strongly Agree,” 3 “Somewhat Agree,” 2 “Somewhat Disagree,”
and 1 “Strongly Disagree.” The last three items employ a 4-point scale but the numerical anchors
are reversed with 4 reflecting “Strongly Disagree” and so forth. The items on this scale do not
reflect an individual’s religious behavior (e.g., time spent in prayer, attendance at a church or
synagogue), but rather the degree to which one’s religion informs one’s life experience and
decisions. Items include, “My faith involves all of my life,” and “Nothing is more important to
me than serving God as best I know.” The internal reliability (Kuder-Richardson alpha) in the
initial sample was .90. Cronbach’s alpha for intrinsic religiosity in this sample was .84.
Psychological distress. The Depression and Anxiety Subscales of the Brief Symptom
Inventory (BSI; Derogatis, 1975; Derogatis & Spencer, 1982; Appendix D) was used to assess
psychological distress. The BSI is a well-validated and reliable measure consisting of 53 items,
which asks participants to report the degree to which they have been “bothered” by various
psychiatric symptoms. Participants rate each item on a 5-point scale (0 to 4), with 0 representing
“Not at all” and 4 representing “Extremely.” The BSI has been shown to be responsive to
paranoid ideation, and psychoticism. The depression and anxiety subscales were used to assess
psychological distress in this sample because they most accurately capture the mental health
status of a community dwelling sample of high functioning older adults such as this one. The
other BSI subscales (e.g., psychoticism and paranoid ideation) capture more severe clinical
symptoms and disorders. The BSI is often used in both clinical research and practice.
The depression subscale assesses hopelessness, suicidality, anhedonia, and sadness. For
example, participants are asked about the degree to which they are distressed or bothered by
“Feeling hopeless about the future.” Cronbach’s alpha in the standardization sample was .85 and
test-retest reliability was .84. Cronbach’s alpha for the depression subscale in this sample
was .83.
The anxiety subscale assesses restlessness, fearfulness, and panic symptoms. For example,
participants are asked about the degree to which they are distressed or bothered by “nervousness
or shakiness inside.” Cronbach’s alpha in the standardization sample was .81 and test-retest
reliability was .79. Cronbach’s alpha for the anxiety subscale in this sample was .79.
The BSI provides two criteria for determining the presence of clinically significant
psychological distress. The Global Severity Index (GSI) consists of the sum of all items the
participant answered divided by the number of items answered (53 if all items were completed).
GSI scores can be standardized, and the author recommends that T scores above 63 be
considered clinically significant. Additionally, cases in which any two subscales are above 63
may be considered clinically significant. The GSI was not appropriate for the current sample
because it includes items which capture severe psychopathology (e.g., psychoticism). Derogatis
37
(1993) does not provide criteria for determining clinical significance on the BSI subscales
individually. However, previous research has applied this same clinical cutoff (T > 63) to the
depression and anxiety subscales (Silver & Frohlinger-Graham, 2000). Further, while the BSI
manual provides norming data for nonpatient male and female samples, the BSI was not
validated for use with older adults. The average age of nonpatient adults in the original
normative sample was 46. Hale, Cochran, and Hedgepath (1984) provided BSI norms for older
adults (N = 565; Mean age = 73). Means differed between the original adult sample and the
sample of older adults on 7 out of the 9 subscales. These means were used to calculate
Physical Health. Following Hooker, Monahan, Shifren, and Hutchinson (1992), physical
health was assessed using a 4-item scale assessing the degree to which participants believe their
health to be adequate (Appendix E). Items capture general state of health, the extent to which
physical health interferes with activity, perceptions of one’s own health compared to others of
the same age, and how often one worries about one’s physical health. Hooker et al. note that
prior research suggests that items assessing self-perception of health is highly related to
morbidity and mortality (Idler & Kasl, 1991; Kaplan & Camacho, 1983). Cronbach’s alpha in
Social Support. Social support was assessed using the Social Support Questionnaire –
Short Form (SSQSR; Sarason & Shearin, 1986) which is presented in Appendix F. The SSQSR
is an abbreviated version of the 27-item scale developed by Sarason, Levine, Basham, and
Sarason (1983) and consists of the 6 items from the full measure which have the higher scale
factor loading (Sarason, Shearin, Pierce, & Sarason, 1987). The SSQSR items, like those on the
full scale, consist of two parts. The first part asks individuals to name the number of people (e.g.,
38
family, non-family, and other) upon whom they can depend for support in a particular situation
and the second part asks how satisfied the individual is with that level of support. The SSQSR
yields two subscales which capture social support Number (SSQN) score and social support
Satisfaction (SSQS) score. Satisfaction items rest on a 6-point Likert scale where 1 = “Very
Dissatisfied” and 6 = “Very Satisfied.” A sample items includes, 1: “Whom can you really count
on to be dependable when you need help?” 1a: “How satisfied are you with that level of
support?” This study uses only the social support Satisfaction scores. Cronbach’s alpha in this
Personal Mastery. Sense of personal control was assessed using the Personal Mastery
Scale (Pearlin & Schooler, 1978; Appendix G). This scale consists of 7 items which capture the
degree to which participants perceive themselves as possessing personal control over life
outcomes. Responses are made on a 4-point Likert scale ranging from 1 = strongly agree to 4 =
strongly disagree. A sample item includes “I often feel helpless in dealing with the problems in
my life.” Previous research has shown that this scale possesses adequate psychometric
properties (Pearlin, Meneghan, Lieberman, & Mullan, 1981; Pearlin & Schooler, 1978). This
measure is highly correlated with related scales including the general self-efficacy scale and
locus of control scale (Woodruff & Cashman, 1993). The Personal Mastery Scale has been
shown to have a Cronbach’s alpha of .70 or higher (Turner & Noh, 1988; Marshall & Lange,
1990). Cronbach’s alpha in this sample was .68. See Table 1 for study constructs and matching
measurement scales.
Procedures
Participants for this study included community dwelling older adults. Those referred for
this study were identified by their physician, clergy person, social worker, or senior center
39
Table 1
Variable Measure
Religiosity:
Organizational The Organizational Religiosity Scale (Chatters, Levin, &
Taylor, 1992)
Intrinsic The Intrinsic Religiosity Scale (Hoge, 1972)
Psychological
Distress:
Depression The Brief Symptom Inventory (BSI): Depression
Subscale (Derogatis & Spencer, 1982)
Anxiety The Brief Symptom Inventory (BSI): Anxiety Subscale
(Derogatis & Spencer, 1982)
Resources:
Demographic:
Financial Adequacy Perceived Financial Adequacy (Liang, Dvorkin, Kahana,
& Mazian, 1980)
Education Years of formal schooling
40
employee as potential candidates for counseling due to a recent transition or loss (e.g., the death
of a spouse). However, participants typically had not received psychotherapy in the past or been
diagnosed with a mental illness at any point in their lives. Any participant who reported
receiving mental health treatment in the last five years was not included in the study.
Each participant was first contacted by phone and those who agreed to participate were
interviewed in person (See Appendix H for Informed Consent). Of those contacted, the
preponderance agreed to take part in the study (96%). Data were collected by graduate students
who were trained to conduct interviews with older adults using standardized instruments.
Interviews began with the collection of demographic information and lasted approximately two
hours. After each interview, the participant was thanked and given a small gift and certificate of
participation.
Data Analysis
Correlational analyses were completed to identify variables which co-vary with the dependent
measures of depression and anxiety. Prior research suggests that physical health and social
support are related to better mental health in late life (Koenig, Hays, George, Blazer, Larson, &
colleagues, 1997) as is sense of personal control (Fiori, Brown, Cortina, & Antonucci, 2006). In
addition, demographic variables including age, financial adequacy (Liang, Dvorkin, Kahana, &
Mazian, 1980; Appendix I), and education were also entered into correlational analyses. Finally,
the chi-square test of independence was used to insure that religious affiliation and gender were
not related to one another, nor age, education, and financial adequacy.
In the primary analysis, linear regression was performed to assess religious affiliation and
(education, physical health, social support, personal efficacy, and psychological distress). Second,
multiple linear regression analyses were performed to account for the potentially confounding
factors with respect to the relationship between religiousness and depression and anxiety.
Demographic variables were entered in step one of the regression analyses, including gender,
religious affiliation, an education. Next, resource variables were entered. Finally, religiosity
variables were entered followed by the interaction terms. Following Aiken and West (1991), the
main effect terms were centered prior to computing the interactions in order to minimize
colinearity between raw and product terms. The Dunn method (Dunn, 1961; Glass & Hopkins,
1984) was used to control for Type 1 error rates associated with multiple significance tests in
omnibus hypotheses tests for linear regression analyses. The Dunn method uses the Bonferroni
inequality to determine critical t values. First, the alpha value is adjusted up by multiplying it by
the number of significance tests. For instance, for an analysis with 10 significance tests, α
= .01(10) yields a new alpha level of .10 for that family of comparisons. The adjusted alpha
value, degrees of freedom, and number of contrasts are used to determine a revised critical t
Flom and Strauss (2003) recommend graphing interactions in linear and logistic
regression to aid interpretation. Line graphs were therefore generated for significant findings in
order to identify the combination of groups (e.g., male or female) and variable levels (e.g., higher
symptoms.
42
Chapter IV
RESULTS
The results are organized into four sections. First, the preliminary analyses are presented
which includes initial tests of skewness, kurtosis, and normality as well as correlational analysis,
chi-square test of independence, and descriptive statistics. Second, linear regression analyses are
presented in the primary analysis section which addresses study hypotheses and research
clinical depression and anxiety are offered. Finally, findings from the primary and supplemental
Preliminary Analysis
Skewness and kurtosis tests for the continuous predictors and outcome variables were
completed. Skewness and kurtosis scores which fall between 1 and -1 indicate a normal
Means, standard deviations, ranges, and alpha levels (theoretical and observed) for all
study variables are included in Table 2. Means, standard deviations, and ranges are reported
separately for Christians and Jews (Table 3) and for men and women (Table 4). The chi-square
test of independence was completed to assess the association between religious affiliation and
gender and to insure their independence from other demographic variables including age,
education, and financial adequacy. A median split was performed for age (median = 77),
education (median = 12 years of formal schooling), and perceived financial adequacy (median =
3; “It is just enough”). There was no association between religious affiliation and age, χ2 (1, N =
143) = 3.14, p = .08, gender, χ2 (1, N = 143) = .35, p = .56, or financial adequacy, χ2 (1, N = 142)
= .85, p = .36. There was an association between religious affiliation and education. Jews
43
Table 2
Mean, Standard Deviation, Range, and Cronbach’s Alpha for Study Variables
Observed Theoretical Observed
Variable M SD Range Alpha Alpha
Note. aRange of item factor coefficients; J = Jewish; C = Christian; M = Male; F = Female; Org =
Organizational
44
Table 3
Social Support 4.56 1.52 1.00-6.00 .92 4.93 1.32 1.00-6.00 .87
Personal Efficacy 2.48 .59 1.14-4.00 .74 2.65 .55 1.57-4.00 .61
Org Rel 1.81 .74 1.00-3.80 .79 1.83 .64 1.00-3.20 .77
Intrinsic Rel 2.39 .65 1.30-3.90 .85 1.96 .56 1.00-3.00 .80
Table 4
Social Support 4.73 1.26 1.60-6.00 .85 4.74 1.52 1.00-6.00 .92
Personal Efficacy 2.49 .60 1.14-3.29 .78 2.60 .55 1.29-4.00 .62
Org Rel 1.79 .75 1.00-3.20 .83 1.84 .66 1.00-3.80 .75
Intrinsic Rel 2.03 .59 1.00-3.40 .85 2.27 .66 1.10-3.90 .84
displayed higher levels of education than Christians, χ2 (1, N = 143) = 5.71, p = .02. There was
no association between gender and age, χ2 (1, N = 143) = 1.40, p = .24, education, χ2 (1, N = 143)
Pearson product moment correlations were calculated to identify salient control variables
(See Table 5). Age was positively associated with financial adequacy (r = .19, p < .05),
negatively associated with social support (r = -.18, p < .05), and positively associated with
organizational religiosity (r = .20, p < .05). Being Christian was associated with lower levels of
education (r = -.21, p < .05) and higher levels of intrinsic religiosity (r = .34, p < .01) than being
Jewish. Education (years of formal schooling) was positively associated with higher levels of
personal efficacy (r = .27, p < .01) but negatively associated with intrinsic religiosity (r = -.22, p
< .01) and anxiety (r = -.41, p < .01). In terms of gender, being female was associated with
higher levels of intrinsic religiosity (r = .18, p < .05), depression (r = .25, p < .01), and anxiety (r
= .45, p < .01) than being male. Financial adequacy was positively associated with organizational
religiosity (r = .30, p < .0). Perceived health was positively associated with personal efficacy (r
= .33, p < .01) and organizational religiosity (r = .30, p < .01), but negatively associated with
depression (r = -.32, p < .01) and anxiety (r = -.28, p < .01). Social support was positively
associated with organizational religiosity (r = .28, p < .01) and intrinsic religiosity (r = .16, p
< .05) but negatively associated with depression (r = -.32, p < .01) and anxiety (r = .20, p < .05).
Personal efficacy was positively associated with organizational religiosity (r = .30, p < .01) but
negatively associated with intrinsic religiosity (r = -.21, p < .05), depression (r = -.33, p < .01),
and anxiety (r = -.24, p < .01). Organizational religiosity was negatively associated with anxiety
(r = -.21, p < .05). Depression and anxiety were positively associated (r = .47, p < .01).
47
Table 5
1. Age — -.13 .02 .10 .19* .70 -.18* .03 .20* .07 -.04 .08
2. Religion(J = 0, C = 1) — -.05 -.21* -.14 .06 -.13 -.15 -.01 .34** .03 -.02
3. Gender(M = 0, F = 1) — -.10 -.09 .12 .01 .09 .03 .18* .25** .45**
4. Education (Years) — .11 .14 .04 .27** .19* -.22** -.12 -.41**
12. Anxiety —
47
*p < .05; **p < .01
48
(depression and anxiety) and all control variables except age and perceived financial adequacy.
Therefore, neither age nor financial adequacy was included in multivariate analyses.
In sum, preliminary analyses indicated the data used in this study did not violate the
assumption of normality. Descriptive statistics were presented and the chi-square test of
independence indicated that religious affiliation and gender were not associated. Neither
religious affiliation nor gender was associated with age or financial adequacy. Religious
affiliation was associated with education (Jews displayed higher levels of education than
Christians) but gender was not related. Bivariate correlations indicated that being female was
associated with higher levels of intrinsic religiosity and number of depression and anxiety
symptoms than being male. Resource variables (i.e., perceived health, social support, personal
efficacy) all displayed a negative association with depression and anxiety. Being Christian was
associated with lower levels of education and higher levels of intrinsic religiosity than being
Jewish. Organizational religiosity was positively associated with education, financial adequacy,
perceived health, social support, and personal efficacy. Organizational religiosity was negatively
associated with anxiety. Depression and anxiety displayed a strong positive association. These
preliminary results provide support for study hypotheses and suggest that further analysis is
required.
Primary Analysis
comparable levels of organizational religiosity, while Christians would display higher levels of
health, social support, personal efficacy, and psychological distress were included in step 1 as
controls. As indicated in Table 6, there was no significant difference between Christians and
Christians displayed higher levels of intrinsic religiosity (p < .001, t = 4.26) than Jews after Dunn
Hypothesis II. Hypothesis II suggested that women would display higher levels of
organizational and intrinsic religiosity than men. There was limited evidence to support this
hypothesis. Table 6 reveals that, contrary to Hypothesis II, men and women did not differ in their
religiosity than men (p = .023, t = 2.29). However, after Dunn post-hoc correction (α = .05, t-
critical = 2.68), there was no significant difference between men and women in intrinsic
Hypothesis III. Hypothesis III predicted that there would be religious affiliation
differences in number of depression and anxiety symptoms. It was predicted that Jews would
display more symptoms of depression and anxiety than Christians. Contrary to our hypothesis,
there was no difference between Christians and Jews in number of depression (p = .82) and
Two linear regressions were completed to assess Hypothesis III as well as subsequent
hypotheses and research questions. Demographics including religious affiliation, gender, and
education were entered in step 1. In step 2 resources were entered including perceived health,
50
Table 6
Linear Regression Predicting Organizational Religiosity from Religious Affiliation and Gender
Step 1 Step 2
B SEb β B SEb β
Education .02 .48 .09 .03 .02 .11
Physical Health .13 .07 .16 .12 .07 .16
Social Support .10* .04 .20 .10* .04 .20
Personal Efficacy .17 .11 .14 .17 .11 .14
Psychological Distress -.15 .12 -.12 -.16 .13 -.13
Religion (J = 0, C = 1) .10 .11 .07
Gender (M = 0, F = 1) .07 .12 .05
∆R2 .01
2
R .20*** .21***
Note. J = Jewish; C = Christian; M = Male; F = Female
Significance values reflect Dunn post-hoc correction for multiple comparisons
*p < .10;** p < .05; ***p < .01
51
Table 7
Linear Regression Predicting Intrinsic Religiosity from Religious Affiliation and Gender
Step 1 Step 2
B SEb β B SEb β
Education -.04 .02 -.17 -.02 .02 -.09
Physical Health .07 .07 .09 .05 .07 .06
Social Support .09* .04 .20 .11** .04 .24
Personal Efficacy -.23 .10 -.21 -.23 .10 -.20
Psychological Distress .06 .12 .05 .03 .12 .02
Religion (J = 0, C = 1) .43*** .10 .33
Gender (M = 0, F = 1) .25 .11 .19
∆R2 .13
2
R .12** .25***
Note. J = Jewish; C = Christian; M = Male; F = Female
Significance values reflect Dunn post-hoc correction for multiple comparisons
*p < .10;** p < .05; ***p < .01
52
social support, and personal efficacy. In step 3, religiosity variables and interaction terms were
entered. In Table 8, the analysis reveals no difference between Christians and Jews in number of
depression symptoms (p = .82). Likewise, in Table 9, the analysis reveals no difference between
Hypothesis IV. Hypothesis IV predicted that women would report a higher number of
depression and anxiety symptoms than men. This hypothesis was confirmed. Table 8 indicates
that women reported more symptoms of depression than men (p < .01, t = 4.14) after Dunn post-
hoc correction (α = .05, t-critical = 2.93). Likewise, Table 9 indicates that women reported more
symptoms of anxiety than men (p = .001, t = 5.85) after Dunn post-hoc correction (α = .05, t-
critical = 2.63).
be inversely associated with number of depression and anxiety symptoms. Contrary to our
hypothesis, higher levels of organizational religiosity were associated with a higher number of
depression (non-adjusted test only) and anxiety (both non-adjusted and adjusted tests) symptoms.
There was no association between intrinsic religiosity and number of depression and anxiety
symptoms.
associated with a higher number of depression symptoms (p < .05, t = 2.22). However, after
Dunn post-hoc correction (α = .10, t-critical = 2.70) there was no association between
organizational religiosity and depression symptoms (See Table 8). There was no association
between intrinsic religiosity and number of depression symptoms (p = .25). Table 9 indicates that
higher levels of organizational religiosity were associated with a higher number of anxiety
53
Table 8
53
54
Table 9
54
55
symptoms (p < .01, t = 2.85) after Dunn post-hoc correction (α = .10, t-critical = 2.70). There
was no association between intrinsic religiosity and number of anxiety symptoms (p = .40).
between organizational religiosity and number of depression and anxiety symptoms would vary
based upon religious affiliation. Likewise, Research Question 1 also explored whether or not the
association between intrinsic religiosity and number of depression and anxiety symptoms would
vary based upon religious affiliation. Prior research suggests that Christians will display a
positive association between the personal and spiritual aspects of religiosity and mental health
(Cohen, 2002) while Jews will not. On the other hand, both groups have displayed an association
organizational religiosity (p < .01, t = 2.87) after Dunn post-hoc correction (α = .10, t-critical =
2.70). Higher levels of organizational religiosity were associated with a higher number of
symptoms of depression among Jews than Christians. On the other hand, lower levels of
organizational religiosity were associated with a higher number of depression symptoms among
Christians than Jews (See Figure 1). The relationship between intrinsic religiosity and number of
depression symptoms did not vary based upon religious affiliation (p = .11).
Anxiety. Table 9 indicates that the relationship between organizational religiosity and
anxiety symptoms did not vary based upon religious affiliation (p = .51). There was an
interaction effect between religious affiliation and intrinsic religiosity in association with anxiety
symptoms (p < .05, t = 2.37) before Dunn post-hoc correction (α = .10, t-critical = 2.70). Higher
levels of intrinsic religiosity were associated with a higher number of anxiety symptoms
56
among Jews than Christians. On the other hand, lower levels of intrinsic religiosity were
associated with a higher number of anxiety symptoms for Christians than Jews.
Research Question II. Research Question II explored whether the relationship between
religiousness and the number of depression and anxiety symptoms varies based upon gender.
There is evidence that the association between organizational religiosity, and lower depression
and better well-being is stronger for older men than older women (McFarland, 2009). Research
exploring how the relationship between intrinsic religiosity and mental health varies by gender
has yielded mixed results. However, no study has yet explored the gender x intrinsic religiosity
Depression. Table 8 indicates that the relationship between organizational religiosity and
the number of depression symptoms did not vary by gender (p = .66). Likewise, the relationship
between intrinsic religiosity and number of depression symptoms did not vary by gender (p =
.30).
Lower levels of organizational religiosity were associated with a higher number of anxiety
symptoms among women than men (p < .01, t = 3.37) after Dunn post-hoc correction (α = .10, t-
critical = 2.70). At higher levels of organizational religiosity, men and women did not differ in
number of anxiety symptoms (See Figure 2). The relationship between intrinsic religiosity and
(Hypotheses III, IV, V, and Research Questions I and II), logistic regression analysis was
completed to assess risk for clinical depression and anxiety. Logistic analysis is desirable
58
Figure 2. Relationship between organizational religiosity and anxiety symptoms for men and
women
59
because it captures clinically significant depression and anxiety which cannot be examined when
outcome variables remain continuous. While linear analysis assesses participants’ number of
symptoms, logistic analysis captures whether or not participants differentially meet criteria for a
disorder. Although scores falling into separate groups may be close in value (e.g., if the cutoff
for clinical depression is 1.0, scores of .9 and 1.1 will fall into different groups), the distinction is
valid when examining a sample of scores. Therefore, logistic analysis was deemed appropriate
because of the meaningful difference between clinical and non-clinical distress and in the interest
of obtaining a more complete picture of participants’ mental health. Logistic regression was
depressed/anxious). For men, a T score of 63 (the clinical cutoff) was equal to a raw score of
1.08 on the depression scale and .81 on the anxiety scale. For women, a T score of 63 was equal
to a raw score of 1.30 on the depression scale and 1.19 on the anxiety scale. See Table 10 for the
coefficient and odds ratio. Odds ratios (OR) assess the relative risk associated with each variable
falling above the clinical cutoff. Odds ratios are calculated by dividing the probability a positive
outcome by the probability of a negative outcome. In this case, a positive outcome indicates that
anxiety scales. On the other hand, a negative outcome indicates non-clinical levels of depression
or anxiety. For categorical variables (e.g., religious affiliation and gender), the odds ratio is the
predicted change in odds of a positive outcome in one group compared to another. For
continuous variables, the odds ratio is the predicted change in odds of a positive outcome per
60
Table 10
Not Depressed
n =65 (45.45%) 38(55.07%) 27(36.49%) 28(57.14%) 37(39.36%)
Depressed
31(44.93%) 47(63.51%) 21(42.86%) 57(60.64%)
n = 78 (54.55%)
Not Anxious
34(49.28%) 44(59.50%) 33(67.35%) 45(47.87%)
n = 78 (54.55%)
Anxious
35(50.73%) 30(40.54%) 16(32.65%) 49(52.13%)
n = 65 (45.45%)
61
unit increase on the variable’s scale. In this study, when odds ratios are less than 1, steeper
Predictors with odds ratios under 1 always have negative regression coefficients. On the other
hand, when odds ratios are greater than 1, steeper regression coefficients correspond to an
increased risk of clinical depression and anxiety. Predictors with odds ratios over 1 always have
positive regression coefficients. Logistic regression analysis also yields confidence intervals.
When the confidence interval falls below 1, it indicates a lower chance of a positive case (i.e.,
decreased vulnerability). On the other hand, when the confidence interval falls above 1, it
The Bonferroni post-hoc correction (Rice, 1989) was used to control for multiple
comparisons in logistic regression. This correction divides the alpha level by the number of
significance tests in the analyses in order to derive a more stringent standard for statistical
significance. For instance, the final step of logistic regression analysis includes 12 significance
Hypothesis III. There was a main effect for religious affiliation on clinical depression that
Contrary to our hypothesis, Christians were nearly twice as likely to fall above the clinical cutoff
for depression as Jews (OR = 1.98, 95% CI = .98 – 4.01). The 95% confidence interval indicates
that the risk for clinical depression among Christians may be as much as four times that of the
Consistent with Hypothesis III, there was a main effect for religious affiliation on clinical
anxiety (p < .01; See Table 12) after Bonferroni post-hoc correction (α = .008). Christians were
74% less likely than Jews to fall above the clinical cutoff for anxiety (OR = .26, 95% CI = .10 –
62
Table 11
Logistic Regression Predicting Clinical Depression from Organizational and Intrinsic Religiosity
Model 1 Model 2 Model 3
Demographics Demographics and Resources Religiosity and Interactions
1 Religion (J = 0, C = 1) .68 3.61 1.98 .64 2.21 1.89 1.11 3.66 2.90
Gender (M = 0, F = 1) .73 3.79 2.07 1.27** 7.71 3.58 2.50** 12.01 12.14
Education -.12 4.11 .88 -.06 .59 .95 -.06 .38 .94
2 Perceived Health -.97*** 13.77 .38 -1.21*** 11.19 .30
Social Support -.42** 7.40 .66 -.34 3.32 .71
Personal Efficacy -1.01 6.02 .36 -2.21** 11.93 .11
3 Org Religiosity 2.45 1.52 11.53
Intrinsic Religiosity .60 .05 .83
Religion x Org Religiosity 3.39*** 12.56 29.80
Gender x Org Religiosity -1.91 3.15 .15
Religion x Int Religiosity .46 .22 1.56
Gender x Int Religiosity .90 .59 2.46
χ2, df, p 14.06, 3, p = .003 39.29, 3, p < .001 35.83, 6, p < .001
Note. OR = odds ratio; M = Male; F = Female; J = Jewish; C = Christian; Org = Organizational; Int = Intrinsic
Significance values reflect Bonferroni correction for multiple comparisons
*p < .05;** p < .01; ***p < .001
62
63
Table 12
Logistic Regression Predicting Clinical Anxiety from Organizational and Intrinsic Religiosity
Model 1 Model 2 Model 3
Demographics Demographics and Resources Religiosity and Interactions
1 Religion (J = 0, C = 1) .74 3.83 .48 -1.36** 8.23 .26 -1.60 7.86 .20
Gender (M = 0, F = 1) .68 3.08 1.97 1.19 6.42 3.27 2.03** 10.48 7.61
Education -.24*** 13.01 .78 -.24** 8.46 .79 -.31** 9.14 .74
2 Perceived Health -.77** 7.49 .46 -1.00 8.40 .37
Social Support -.53** 10.36 .59 -.66** 10.36 .52
Personal Efficacy -1.06 6.57 .35 -1.06 4.42 .35
3 Org Religiosity 1.26 .56 3.52
Intrinsic Religiosity -4.27 3.04 .01
Religion x Org Religiosity 1.31 2.85 3.72
Gender x Org Religiosity -.39 .21 .68
Religion x Int Religiosity .16 .03 1.18
Gender x Int Religiosity -2.54 5.99 .08
χ2, df, p 21.68, 3, p < .001 38.05, 3, p < .001 12.90, 6, p = .045
Note. OR = odds ratio; M = Male; F = Female; J = Jewish; C = Christian; Org = Organizational; Int = Intrinsic
Significance values reflect Bonferroni correction for multiple comparisons
*p < .05;** p < .01; ***p < .001
63
64
.65). The 95% confidence interval indicates that Christians may be as much as 90% less likely to
Hypothesis IV. As predicted, there was a main effect for gender on clinical depression (p
< .01; See Table 11) after Bonferroni post-hoc correction (α = .008). This finding should be
interpreted with caution because the addition of predictors in step 2 may have detracted from the
variance accounted for by religion and education variables. Nevertheless, women were nearly
four times as likely as men to fall above the clinical cutoff for clinical depression (OR = 3.58,
95% CI = 1.45 – 8.79). The 95% confidence interval indicates that the risk for clinical depression
associated with being female could be as high as eightfold that of men in this study.
As predicted, there was a main effect for gender on clinical anxiety in step 3 of the model
(p = .001; See Table 12) after Bonferonni post-hoc correction (α = .004). Once again, this finding
should be interpreted with caution because the addition of predictors in step 3 may have
detracted from the variance accounted for by demographic and resource variables. Women were
nearly eight times as likely as men to fall above the clinical cutoff for anxiety (OR = 7.61, .95%
CI = 2.23 – 26.01). The 95% confidence interval indicates that the higher risk for clinical anxiety
associated with being female could be as high as twenty six-fold that of men in this sample.
Hypothesis V. Supplemental analysis did not indicate a main effect for religiosity on
clinical depression. Neither organizational religiosity (p = .22) nor intrinsic religiosity (p = .83)
was associated with clinical depression in this sample. Likewise, there was no association
between organizational religiosity and clinical anxiety. However, there was a trend toward
significance for the association between intrinsic religiosity clinical anxiety (p = .08) prior to
Bonferroni post-hoc correction (α = .004). For every one point increase on the intrinsic
65
religiosity scale, participants were 99% (OR = .01, 95% CI = .00 – 1.70) less likely to fall below
religion and organizational religiosity for clinical depression (p < .001; See Figure 3) after
Bonferroni post-hoc correction (α = .004). For every one point increase on the organizational
religiosity scale, Jews were nearly thirty times more likely to fall above the clinical cutoff for
depression than Christians (OR = 29.80, 95% CI = 4.56 – 194.74). On the other hand, as values
on the organizational religiosity scale decrease, Christians are more likely to fall above the
clinical cutoff for depression than Jews (See Table 11). The association between intrinsic
religiosity and clinical depression did not vary by religious affiliation (p = .64).
There was an interaction between religious affiliation and organizational religiosity for
clinical anxiety that trended toward significance (p = .091) prior to Bonferroni post-hoc
correction (α = .004). For every one point increase on the organizational religiosity scale, Jews
were nearly four times as likely (OR = 3.72, 95% CI = .81 – 17.10) to fall above the clinical
cutoff for anxiety than Christians (See Table 12). The association between intrinsic religiosity
Research Question II. Consistent with expectations, there was an interaction between
gender and organizational religiosity on clinical depression that trended toward significance (p
= .076) prior to Bonferroni post-hoc correction (α = .004). For every one point increase on the
organizational religiosity scale, men were 85% (OR = .15, 95% CI = .02 – 1.22) less likely to be
depressed than women (See Table 11). The association between intrinsic religiosity and clinical
The association between organizational religiosity and clinical anxiety did not vary by
66
Figure 3. Relationship between organizational religiosity and risk for clinical depression for
Christians and Jews
67
gender (p = .65). There was an interaction between gender and intrinsic religiosity (p < .05) that
was significant prior to Bonferroni post-hoc correction (α = .004). For every one point increase
on the intrinsic religiosity scale men were 92% (OR = .08, 95% CI = .01 – .60) less likely to be
Summary
Hypothesis I was confirmed in the present analysis. Christians reported higher levels of
intrinsic religiosity, but not of organizational religiosity when compared to Jews. There was
some evidence to support Hypothesis II. Women reported higher levels of intrinsic religiosity
than men prior to post-hoc adjustment, but not of organizational religiosity. For Hypotheses III,
linear regression analysis indicated no difference between Christians and Jews in number of
depression and anxiety symptoms. However, supplemental logistic regression analysis revealed
that Christians’ risk for clinical anxiety was less than half that of Jews. Hypothesis IV was
confirmed. Women reported a higher number of both depression and anxiety than did men, at
both symptom and clinical levels. There was no evidence to support Hypothesis V. In fact,
associated with fewer depression symptoms and lower risk for clinical depression for Christians
than Jews. Higher levels of organizational religiosity were associated with a higher number of
depression symptoms for Jews than for Christians while the opposite pattern emerged at lower
levels of organizational religiosity. Logistic regression results were consistent with linear
analysis. The association between higher levels of organizational religiosity and risk for clinical
For Research Question II, one significant interaction emerged after post-hoc analysis.
Linear analysis indicated that lower levels of organizational religiosity were associated with a
higher number of anxiety symptoms for women than men, while men and women did not differ
in anxiety symptoms at higher levels organizational religiosity. In logistic analysis, there were
trends towards significance showing that higher levels of religiousness were associated with
increased risk of clinical depression and anxiety for women while there was no difference in risk
between men and women at lower levels of organizational religiosity. However, these findings
Finally, in the model as a whole, demographics (gender, religion, and education) and
resource variables (perceived health, social support, and personal efficacy) tended to account for
a greater amount of variance in depression and anxiety than religiosity variables and interaction
terms. This was true in both the linear and the logistic analyses.
69
Chapter V
DISCUSSION
The purpose of this study was to examine how the association between religiousness and
psychological distress varies by religious affiliation and gender. Only one study has explored
how the association between religiousness and mental health varies between Christians and Jews
and no prior work has explored this question using a sample of older adults. There has been prior
research exploring how the relationship between religiousness and mental health varies by
gender but the results have been inconsistent. That is, in some cases women higher in
religiousness were found to have better mental health and in others, men higher in religiousness
had better mental health. This study sought to further our understanding of how organizational
and intrinsic religiosity are associated with mental health in late life for men as opposed to
women.
In the following sections, the findings of this study are discussed in the context of the
hypotheses and research questions presented earlier in this dissertation. The results of this study
are contrasted with prior work in the same area. Alternative explanations are presented for the
significant findings, and potential explanations for the null results are explored. The study
concludes with a discussion of its limitations, implications, and suggestions about future research.
intrinsic religiosity but not in organizational religiosity. More specifically, it was predicted that
Christians would display higher levels of intrinsic religiosity than Jews, but that these two groups
would not differ in their level of organizational religiosity. This hypothesis was confirmed.
70
services and events. Morris (1996) notes that both assent (as in Christianity) and descent
religions (as in Judaism) facilitate community. While Judaism is a descent religion based upon
common ethnicity and Christianity an assent religion which determines membership through
shared beliefs, both traditions require participation in religious services. For Jews, religious
services provide social connectedness which is facilitated through ritual and an emphasis on
Jewish history. On the other hand, Christian services solidify membership through statements of
shared beliefs. Catholics, for instance, recite a Profession of Faith during mass which affirms
members’ belief in Jesus, the Trinity, and other points of theology. Despite differences in the
content of Christian and Jewish services, religious participation is vital for both faiths.
In addition to attendance at services, both Christianity and Judaism provide members the
opportunity to join Church or Synagogue sponsored organizations and initiatives. Jews may
engage in social activism or other charity work through their local Synagogue or Jewish
Federation. Among other initiatives, The Jewish Federation advocates for the people of Darfur
and other vulnerable populations throughout the world. Likewise, Christian churches offer
members the opportunity to participate in ancillary groups. For instance, the St. Vincent de Paul
Society is a Catholic organization devoted to helping those in need such as the poor and victims
of natural disasters. It is also common for churches and synagogues alike to hold gatherings for
its members which provide further opportunity for participation and fellowship.
While Christians and Jews were not herein found to differ in level of organizational
religiosity, as predicted, Christians displayed higher levels of intrinsic religiosity than Jews. This
suggests that Christians tend to draw upon religion more in their daily lives, look to God when
making decisions, and use their religious beliefs to guide their actions more so than do Jews.
71
Christianity’s emphasis on beliefs, which are often recited at weekly services, may engender a
personal relationship with God for members to draw upon. Catholic psychoanalyst Ana-Maria
Rizzuto (2004) suggests that Catholics develop an internal representation of God that is often
internalized object with whom Catholics feel personally connected. As a result, Christians may
carry over their religion and connection with God into other parts of their life more so than Jews.
While Judaism includes some core beliefs, the exact nature of those beliefs is not agreed
upon. Maimonides (12th Century/1967) provides 13 principles of faith, among them, a belief in
God, that God is one, that God is not physical, and that it is proper to serve God. However,
because Jewish authorities do not pinpoint the exact nature of God or how best to know Him and
serve Him, these points remain the topic of debate in Jewish communities. Collective agreement
is always resisted (Morris, 1996). As God’s true qualities are always in question, Jews tend not
to attribute human qualities to God, making religion less likely to inform decision making and
day-to-day behavior. Intrinsic religiosity may well be higher among Orthodox Jews than the non-
Hypothesis II predicted that there would be gender differences in religiousness such that
women would display higher levels of organizational and intrinsic religiosity than men. There
was limited evidence to support this hypothesis. Women displayed higher levels of intrinsic
religiosity than men (prior to post-hoc correction) but not higher levels of organizational
religiosity. After Dunn post-hoc correction for multiple comparisons, women and men displayed
Prior work has shown that women tend to be more organizationally religious than do men
(See Francis, 1997 for a review). Francis suggests that theories explaining gender differences in
religiousness can be divided into two categories: (1) social and contextual factors and (2)
individual psychological characteristics. The first group of theories suggests that gender role
socialization and the relative position of men and women in familial and social structures
account for higher levels of increased religiousness in women. The second group of theories
suggests that psychological differences such as personality and gender orientation lead to gender
differences in religiousness. Women tend to be more socially orientated than men (Eagly &
Crowly, 1986; Gilligan, 1982) and may therefore be more likely to build and maintain
In this sample, however, men and women did not differ in their level of organizational
religiosity. How are we to account for this null finding? McFarland (2009) suggests that men
may seek out activities and organizations after retirement which offer them personal fulfillment.
Therefore, one explanation is that men become increasingly involved in religious organizations
as they age because they have more time and need for formal organizational affiliation and
participation. Religious organizations may fill a gap left by men’s former career endeavors. A
complementary explanation may be that women may become less involved in religious
organizations later in life. Women are often responsible for maintaining a family’s social
connectedness within a place of worship, relationships with clergy, and the friendships
developed in a formal religious setting (Idler, 1987; Koenig, 1984). In late life, women may
transfer part of this responsibility to their husbands as they become more religiously involved.
There was modest evidence that women in the current sample were higher in intrinsic
religiosity than older men, although gender differences in intrinsic religiosity were no longer
73
significant after post-hoc adjustment. Nevertheless, the initial finding is consistent with prior
This difference may have both social and psychological roots. Women’s need for social
connectedness may predispose them to seek counsel from others more readily than men.
Likewise, women may more actively petition God for guidance, seeking help and support from
God just as they would a trusted friend. On the other hand, men are less likely to seek help than
women and may prefer to make decisions independently (Addis & Mahalik, 2003).
Men may also avoid expressions of intrinsic religiosity because such behaviors are
inconsistent with social gender role expectations. The internal experience of religiousness (e.g.,
feeling close to God) is often considered a feminine trait (Zock, 1997) and men reporting higher
levels of religiousness also score higher on scales of femininity (Francis & Wilcox, 1996).
Because men are socialized to avoid behaviors that may be perceived as feminine (Levant &
Pollack, 1995), they may be reluctant to develop a personal relationship with God. Empirical
work has provided further evidence of this association. In a sample of 151 Catholic
undergraduates and seminarians, Mahalik and Lagan (2001) found that men with more
traditional views of gender roles and masculinity were lower in intrinsic religiosity.
men and women in intrinsic religiosity. Men display more risky behaviors than women
(Gottfredson & Hirschi, 1990) while women place a higher value on stability and security. Miller
and Hoffman (1995) note that religion provides an existential risk management strategy which
helps people address questions of meaning, the uncertainties of death, and a desire for
understanding and control. Living their religion daily may lend meaning and understanding to
day-to-day activities for women. By frequently seeking God’s guidance, women may feel they
74
are doing God’s will, which increases their sense of security and control. Both Judaism and
Christianity ascribe to the belief that God will punish those who do not obey His law. The threat
Century/1967) declared, “God rewards those who uphold His laws and punishes those who
violate them.”
Hypothesis III predicted that Christians and Jews would display differences in
psychological distress. It was predicted that Jews would display a higher number of symptoms of
depression and anxiety. In the primary analyses, there was no evidence to support this hypothesis.
In the supplemental analyses, the hypothesis was partially supported. Jews displayed higher risk
for clinical anxiety than Christians after post-hoc correction. Christians’ risk for clinical anxiety
was less than half that of Jews. On the whole, however, evidence for Hypothesis III is tenuous.
The following discussion offers potential explanations for the limited findings and explores
possible reasons for the existence of religious affiliation differences at clinical levels anxiety.
This sample’s unique characteristics may in part explain the relatively weak findings.
Participants were referred to this study because they seemed more distressed than before, and in
many cases had recently gone through a transition, such as the death of a spouse, or other loss. It
may be a result of this kind of circumstance that this sample displays a high number of
depression and anxiety symptoms and high rates of clinical depression and anxiety. The
relatively high level of distress across this sample may thus have diluted depression and anxiety
Differences between Christians and Jews in clinical anxiety but not the continuous
variables derived from number of symptoms suggest that group differences are apparent only at
75
higher degrees of psychological distress. Numerous studies have shown that Jews have higher
rates of depression than Christians in clinical samples (Cooklin, Ravindran, & Carney, 1983;
Flics, 1991; Malzberg, 1973). Less is known regarding Christian-Jewish differences in anxiety;
however, given the high comorbidity of depression and anxiety (Gorman, 1997) it was predicted
that Jews would display higher rates of anxiety than Christians. In the current study, Christians
were less than half as likely to fall above the cutoff for clinical anxiety as were Jews.
One potential explanation involves the circumstances during which this generation came
of age. All participants in this study were born before World War II, between 1905 and 1934.
Jewish participants growing up in this era likely experienced significant personal trauma as
European Jews were systematically exterminated between 1941 and 1945. They may have lost
parents, relatives, or family friends in the Holocaust or may have been Holocaust survivors
themselves. At the very least, these Jewish people were keenly aware of anti-Semitism both
abroad and in the United States in the 1930s and 1940s. Wex (2005) notes that Jews may
experience lower well-being when they perceive themselves as part of a persecuted minority.
While Christian participants may have served or lost family or friends in World War II, they
were not confronted with the genocide of one’s own people as were Jews. Prior research has
shown that trauma in early life and young adulthood increases the likelihood of anxiety later in
life (Bremner, Southwick, Johnson, Yehuda, & Charney, 1993; Kishon-Barash, Midlarsky, &
Johnson, 1999).
Another explanation for elevated risk of clinical anxiety among Jews involves Jewish
teaching regarding the afterlife. Judaism includes a variety of teachings regarding life after death
such as hell, living on through one’s children or the Jewish community as a whole, and
reincarnation (Lamm, 2000; Raphael, 1996). On the other hand, Christian teachings on the
76
afterlife are definitive. As a result, Christians more often believe in life after death than do Jews
(Dixon & Kinlaw, 1982-1983; Klenow & Bolin, 1989-1990; Zedek, 1998). In a recent study,
Cohen and Hall (2009) found that older Jews were not only less likely to believe in the afterlife
than Christians but that they also displayed higher death anxiety. Death anxiety has been linked
to clinical manifestations of anxiety in adults with serious physical illness (Addelbratt & Strang,
2000; Conte, Weiner, & Plutchik, 1982; Safren, Gershuny, & Hendriksen, 2003). It is possible
that the variety of teachings Judaism provides regarding life after death may lead to uncertainty
among older Jews while the crystallized descriptions of life after death in Christianity may be
comforting for its members. Prior work has shown that priming people with mortality increased
belief in the supernatural (Norenzayan & Hansen, 2006). In light of the previous explanation
which highlighted Jewish persecution (which may render mortality more salient for Jews than
Christians), the lack of a definitive teaching on the afterlife may leave Jews without a system for
depression and anxiety symptoms such that women display a higher number of depression and
anxiety symptoms than men. This hypothesis was confirmed. Women reported more symptoms
of depression and anxiety than men and were at greater risk for clinical depression and anxiety.
The following discussion explores explanations for the association between gender and
Women display higher rates of depression than men throughout adulthood (Piccinelli, &
Wilkinson, 2000l; Prince et al., 1999). Gove (1984) suggests that women display higher rates of
depression because they occupy nurturant roles that strain their coping resources and make it
77
difficult for them to get care for themselves when needed. Adherence to traditional gender roles
may be strict among older adults in this sample all of whom were born in the 1930s or earlier.
The cost of caring hypothesis suggests that caretaking often exacts a price (Kessler &
McLeod, 1984). Women may neglect their own needs in favor of those of their husband, family,
and friends. Their significant emotional involvement with family and friends may leave them
Often women serve as the primary caretaker and have many concomitant responsibilities
including childcare, housework and meal preparation, and the maintenance of social
relationships for the family. Unlike professional responsibilities which may be left behind in the
evenings and on weekends, maternal responsibilities are a perpetual concern. Because caretaking
responsibilities never end, women may become especially vigilant regarding incomplete
housework, the well-being of children or grandchildren, and keeping up with social obligations.
The collective burden of this perpetual toil and vigilance may make it difficult for women to
relax or attend to their own needs and lead to heightened anxiety regarding incomplete tasks.
In addition to the stress of caretaking duties, women may have fewer employment
opportunities and tend make lower salaries than men (Ash, Carr, Goldstein, Friedman, & 2004;
Suter, 1973). Poor career prospects may lead to psychological distress and limited financial
resources may make it difficult for women to receive mental health treatment. Prior research has
consistently indicated an association between lower levels of income and higher levels of mental
related to number of depression and anxiety symptoms. Contrary to our hypothesis, higher levels
78
There are a number of possible explanations for the unexpected positive association
between organizational religiosity and number of anxiety symptoms. It should be noted that this
association may not be causal. For instance, it is possible that older adults higher in anxiety may
turn to religion as a coping resource (Koenig & Larson, 1991). Participants in this sample may
have turned to religion after the death of their spouse or other significant losses. The death of a
spouse, especially in late life, may not only lead to symptoms of anxiety but also to existential
questions best addressed by religion. Koenig and Larson (2001) reviewed 76 studies that
examined the relationship between religiousness and anxiety. Ten of these studies reported a
positive association between religiousness and anxiety. Yet, the authors note that while anxiety
often motivates increased religious activity, such activity tends to be associated with lower
Another explanation is the potential use of negative religious coping strategies among
participants in this sample (Pargament, 1997). Negative religious coping often denotes an
adversarial relationship with God. For instance, when people feel that God is punishing them for
their sins, mental health outcomes tend to be poor. On the other hand, maintaining a personal
relationship with God and perceiving Him as a partner during times of difficulty is associated
with better mental health outcomes. Older adults, especially Christians, may be more likely to
engage in negative religious coping than younger adults. So-called hellfire and brimstone
sermons were common in the first half of the 20th century in Christian services. Preachers
routinely evoked the wrath of God and the threat of eternal damnation during their sermons to
encourage virtuous behavior and adherence to religious commandments. While such preaching
79
styles remain common among some Christian groups (e.g., Pentecostals), hellfire and brimstone
preaching is largely considered the product of a bygone era. This shift may have been facilitated
by the Second Vatican Council’s (1962-1965) Sacrosanctum Concilium which liberalized the
Catholic liturgy, granting churches permission to say mass in the vernacular language and
encouraging participation from laity and the integration of local customs (Whitehead, 2009).
Nevertheless, older adults in this sample may have heard such preachers as children or young
adults which perpetuated the attribution of mental and physical ailments to Divine punishment.
While Jewish clergy did not employ fire and brimstone preaching methods, Jews ascribe to the
Torah (i.e., Old Testament in Christian tradition) which exhibits a more vengeful God than the
Christian New Testament. In fact, Cohen, Malka, Rozin, and Chefras (2006) found that Jews
were more likely than Protestants to believe that God would not forgive certain behaviors.
Still another explanation for the positive relationship between organizational religiosity
and anxiety symptoms may be the heightened standards to which religious people hold
themselves. Schafer (1997) notes that along with increased religious importance may come
concern regarding the fulfillment of divine expectations. Heightened religious standards may
result in a failure to live up to religious rules and obligations for some. As people become more
involved in churches and synagogues, they may become more aware of personal obligations to
God and adherence to religious doctrine as well their personal shortfalls in living up to these
standards. The notion of Catholic guilt, which suggests that Catholics tend to feel an excess of
personal responsibility, may in part explain why religious people display more symptoms of
anxiety. Likewise, for Jews, increased religious affiliation may also bring increased ethnic
identification. More religious Jews may be more aware of the sacrifices of the Jewish people
throughout history which may increase their sense of duty toward their people and greater self-
80
enforced demands for religious adherence. On the other hand, those who are less institutionally
involved may be less burdened by religious rules and commitments resulting in better mental
health.
There was also an association between intrinsic religiosity and clinical anxiety that
trended toward significance; however, this association disappeared after post-hoc correction.
Nevertheless, a brief discussion of this trend may be warranted because there is evidence that
intrinsic religiosity may show a stronger inverse association with mental illness than measures of
religious behavior. In a meta-analysis of 34 studies, Hackney and Sanders (2003) found that
personal devotion to God showed the strongest association with depression (inversely associated),
life satisfaction, and self-actualization while institutional measures of religiousness showed the
weakest. The authors suggest that membership and participation in religious institutions may not
be enough to engender the belonging and meaning that religion can provide. Those going
through the motions at religious services may never internalize and personalize religion in a way
and anxiety varied by religious affiliation. There is evidence that both Christians and Jews
display an association between organizational religiosity and better mental health. On other hand,
Christians display an association between religious belief and coping through turning to God and
religious affiliation. Christians displayed a higher association with depression than Jews at lower
81
levels of organizational religiosity and a lower association with depression than Jews at higher
and clinical depression varied by religious affiliation. For every one point increase in
organizational religiosity, Jews’ risk for clinical depression was thirty times that of Christians.
The shape of the slopes in this interaction suggests that far fewer Christians at higher levels of
organizational religiosity are depressed in contrast to Jews for whom slightly more are above the
strongest of the interactions explored in this dissertation. For one, this finding is consistent across
linear and logistic analyses, suggesting that differences persist between Christians and Jews at
both the symptom and clinical levels of depression. The pattern displayed in both linear and
logistic analyses is the same with slopes becoming steeper in logistic analysis (especially for
Christians). The consistency between these two analyses reinforces the integrity of each of them
and provides evidence of a meaningful difference between Christians and Jews in the
One of the most salient differences between Christianity and Judaism is the emphasis in
Christianity on the cultivation of internal states compared to the focus within Judaism on
behavior (Prager & Telushkin, 1981). Hence, one might expect that Christians’ religious activity
would play a more vital part in their mental health maintenance than Jews’ religious activity
plays in theirs. Cohen (2002) suggests that turning to God may be a positive coping strategy for
Christians but mostly irrelevant for Jews. Instead, Jews may cope through ethnic identification
which may, on the one hand, increase stress levels while providing substantial support on the
Jewish services reinforces this distinction. In Christianity, the goal of religious services is to
reconnect with God through identification with Christ’s sacrifice. By identifying with Christ’s
example and atonement with the Father (and renewal of this bond through Communion in the
Catholic mass), so are Christians reconciled with God. Personal difficulties, sins, and hardships
are brought before the Cross of Christ and offered up to God. Churches are constructed to
enhance members’ spiritual connection with the Divine. Vaulted ceilings reach upward, stained
glass windows illuminate the space of worship, music enriches the service, and in Catholic
churches, crucifixes, statues, and frescoes portray dramatic biblical scenes. These physical
fact, it is not uncommon at a Catholic mass, to see people with their heads buried in their hands
crying. Psychologically, the identification with Christ’s sacrifice removes sinfulness, guilt, and
The cathartic experience that religion can provide may thus be more centered on the
worship space for Christians than Jews. While synagogues contain artwork, they tend not to be
as ornate as churches, largely for historical reasons. Because Jews were often forced to migrate
from one place to another due to persecution, extensive investment in the synagogue structure
was either impossible or impractical. Instead of adorning the physical structure of the synagogue,
the structure of Judaism is created through religious laws which govern daily behavior and bind
Therefore along with increased religiousness for Jews may come increased ethnic
identification. While providing benefits for Jews as such heightened personal meaning and
purpose, ethnic identification may also lead to a greater appreciation for Jewish history and anti-
83
Semitism. An appreciation for Jewish existential crisis throughout history and a deep sense of
collective loss may make religious Jews more vulnerable to developing depression (Wex, 2005).
Another explanation for Jews’ higher depression at higher levels of religiosity may be
their tendency to seek help from their religious community when in need of support. That is, the
relationship between higher levels of organizational religiosity and higher levels of depression
Another point worthy of discussion is the higher levels of depression among Christians at
lower levels of religiosity. Many of the differences noted above which may explain why more
religious Christians display less depression than more religious Jews may in turn explain why
less religious Christians display more depression than less religious Jews. Just as active Christian
participation may engender emotional harmony, so too may its absence lead to mental health
decline. After treating a number of lapsed Catholics in the early 20th century, Carl Jung noted
that the most effective treatment for them was to simply get them to “go back to believing”
(McLynn, 1997, p. 414). On the other hand, because Judaism is more community based and not
intended to enhance internal states (Prager & Telushkin, 1981), the absence of religious practice
religiosity and number of anxiety symptoms did not vary by religious affiliation. There was a
trend in the direction of fewer Christians displaying lower risk of clinical anxiety than Jews at
higher levels organizational religiosity (p = .091); however, there was no interaction between
organizational religiosity and religious affiliation in association with clinical anxiety after post-
hoc correction.
Intrinsic Religiosity and Depression. The relationship between intrinsic religiosity and
84
depression symptoms or risk for clinical depression did not vary by religious affiliation. These
null results are noteworthy given that Christians and Jews differed sharply in their level of
intrinsic religiosity (p < .001). The mean score for Christians on the Intrinsic Religiosity Scale
was 2.39 while for Jews it was 1.96. However, it has been noted that higher levels of
religiousness among one group do not equate to significant associations with mental health
measures in that group compared to another (Ellison et al., 2009). For instance, consider that a
preponderance of research has shown that higher levels of religiousness are associated with
better mental health. Furthermore, research also shows that women tend to me more religious
than men. However, despite these established relationships, more religious women do not display
Intrinsic Religiosity and Anxiety. The association between intrinsic religiosity and
anxiety symptoms varied by religious affiliation prior to post-hoc adjustment. Higher levels of
intrinsic religiosity were associated with a higher number of anxiety symptoms among Jews than
Christians. However, after Dunn post-hoc correction there was no interaction between intrinsic
affiliation interactions in this study within the context of prior research, and highlights sampling,
methodological, and measurement differences. Because only one known study has explored how
different dimensions of religiousness are related to mental health among Christians as opposed to
Jews, this discussion will focus primarily on the work of Cohen (2002).
depression, Christians displayed a steeper slope than Jews. This suggests that religious
attendance is more salient for Christians than for Jews in its association with depression. An
85
examination of the correlations in Cohen’s (2002) first study reveals a similar pattern as
displayed in this paper. Catholics and Protestants displayed positive associations between public
religious practice and happiness, while Jews displayed no association. Unfortunately, the low
number of Jews in Cohen’s first study precluded further analyses of Christian–Jewish differences.
The current study found that the association between organizational religiosity and
depression varied between Christians and Jews. This finding contrasts with Cohen’s (2002)
second study which suggested that because organized religious activity is important in both the
Christian and Jewish faiths (Morris, 1996), such activity should be associated with mental health
Differences between Cohen’s work and this study include the sample characteristics and
method of data collection. In Cohen’s first study, the sample consisted of adults with a mean age
of 47.9 compared to the current sample of older adults with a mean age of 76.82. The sample
used in Cohen’s second study contrasts even more sharply with the sample studied here,
consisting of 309 participants with a mean age of 33.33. Furthermore, his sample was gathered
using Internet recruiting methods and a number of students at the University of Pennsylvania and
the University of Michigan participated in Cohen’s study. While specific data are not provided,
Cohen’s sample likely included a group of highly intelligent young adults of high socioeconomic
status.
The age difference between these samples raises questions regarding how younger and
older adults engage their religion and how that engagement is associated with the mental health.
Research has indicated increased religiousness as people age (Koenig, Smiley, & Gonzalez, 1988;
Levin, Taylor, & Chatters, 1995). Older Jews may have a deeper sense of Jewish history and
persecution than younger Jews. Therefore, as they become more religious so may they also
86
become more aware of the perils of practicing Judaism throughout history. On the other hand,
younger generations of American Jews have not faced the same degree of anti-Semitism as older
generations. A 2009 Anti-defamation League survey revealed that 12% of the American
population held anti-Semitic views compared to 29% in 1964 (Anti-Defamation League Survey,
2009). Similarly, older Christians may have a better appreciation for their religion than younger
members. They may have spent a lifetime attending the same church building supportive
relationships with clergy and other members. Greater religious appreciation may allow older
Christians to use their religion to cope in a way that younger Christians have not yet realized.
Another methodological difference between these studies is the type of statistical analyses.
Cohen’s second study revealed that public religious practice was about equally related to higher
life satisfaction for both Christians and Jews. While the power of these associations is not
provided, an examination of the F values for Catholics compared to Jews for the association
between public religious practice (frequency of religious service and activity attendance) and life
satisfaction (The Satisfaction with Life Scale) reveals comparable effects. However, Cohen’s
analyses included separate multiple regressions for Catholics, Protestants, and Jews and therefore
Finally, measurement differences may account for the inconsistency between the results
of Cohen’s study and the current inquiry. For instance, in the study by Cohen (2002),
attendance and activity participation. The Organizational Religiosity Scale employed here not
only asks about frequency of attendance and activity but also formal religious affiliation and the
Perhaps even more pertinent are differences in the mental health measures. Cohen (2002)
assesses life satisfaction using two measures: the Satisfaction with Life Scale (Pavot & Diener,
1993) and the Delighted Terrible Scale (Andrews & Robinson, 1991). Life satisfaction has been
found to correlate negatively with measures of psychological distress and depression (Firsch,
Cornell, Villanueva, & Retzlaff, 1992). Nevertheless, while it may be unlikely that an individual
would be both satisfied with his or her life and depressed, he or she may well be both satisfied
with his or her life and anxious (Headey, Kelley, & Wearing, 1993).
Research Question II explored the degree to which the relationship between religiousness
and psychological distress varies by gender. Research has tended to show that women display a
stronger association between religiousness and better mental health than do men (Ellison, Finch,
Ryan, & Salinas, 2009; Hintikka, Koskela, Kontula, & Viinamäki, 2000; Mirola; 1999; Norton,
Skoog, Franklin, Corcoran, Tschanz, Zandi, et al., 2006; Strawbridge, Shema, Cohen, & Kaplan,
2001). However, McFarland (2009) found that religiousness is associated with depression
(inversely) and better well-being among older men but not older women.
religiosity and number of depression symptoms did not vary by gender. Consistent with prior
research (McFarland, 2009) there was a trend toward significance showing that the relationship
between organizational religiosity and risk for clinical depression varied by gender. However,
the interaction between organizational religiosity and gender in association with clinical
religiosity and the number of symptoms of anxiety was found to vary by gender. At lower levels
88
of organizational religiosity, women displayed a higher number of anxiety symptoms than did
men. Gender did not differ in its association with number of anxiety symptoms at higher levels
religiosity and risk for clinical anxiety did not vary by gender.
Most of the work examining gender differences in the association between organizational
religiosity and mental health has employed depression as the outcome variable. Those studies
that have included anxiety items often lump them in with other dimensions of mental health. For
instance, Hintikka (2000) found that there was a stronger association between attendance at
religious services and better mental health for women than for men. However, the measurement
scale used (the GHQ-12) consists of items assessing anxiety, depression, and esteem. Therefore,
The shape of this interaction reveals that it is at lower levels of organizational religiosity
that women experience more anxiety than men. The slopes for men and women in this
interaction indicate that men display comparable levels of anxiety at low and high levels of
organizational religiosity. On the other hand, women display a steep decline in anxiety
symptoms when moving from low to high levels of religiosity. Mirola (1999) suggests that
because women tend to display more depression and anxiety than men (i.e., they come from a
more extreme position), that they have more to gain from religious involvement.
Why might women display more anxiety symptoms at lower levels of organizational
religiosity than men? One explanation may be women’s higher concern with existential questions
such as death and the afterlife. Indeed, research has shown that women report higher levels of
death anxiety than men (Dattel & Neimeyer, 1990; Harding, Flannelly, Weaver, & Costa, 2005;
Rasmussen & Johnson, 1994). As noted earlier, death anxiety has been associated with anxiety
89
symptoms among patients with serious illness (Adelbratt & Strang, 2000; Conte, Weiner, &
Plutchik, 1982; Safren, Gershuny, & Hendriksen, 2003). Furthermore, previous research has
indicated that religious involvement is related to lower death anxiety (Mathew, Larson, & Barry,
1993). Women who are less religiously active may lack a framework for understanding
existential concerns in late life which leads to increased anxiety. On the other hand, because men
are less anxious about death to begin with, religion may be less important in maintaining mental
This finding is consistent with the framework presented earlier in this paper which
suggests that women are able to derive more benefit from religiousness than men are (Ellison,
Finsh, Ryan, & Salinas, 2009; Mirola, 1999; Norton et al., 2006). One often noted mechanism
for this relationship is women’s ability to build relationships with other members of their church
or synagogue. On the other hand, men may view religious activity as a part of their weekly
routine or be drawn to religious services for the solitude that they offer. Miller and Hoffman
(1995) note that while men may participate in religious activity, they are less likely than women
to use religion as a coping strategy. However, it should be noted that this interaction remained
Another possibility is that women may feel validated by messages of love (more so in
Christianity) and compassion (more so in Judaism) espoused by religious scripture and teaching.
Religious services serve as the point of interaction with scripture for most religious Christians
and Jews. Therefore, service attendance may reinforce the nurturing qualities often associated
with women for which they may feel underappreciated in their day-to-day lives. Such affirmation
religion interactions, the association between intrinsic religiosity and symptoms of depression
did not vary by gender. Similarly, the relationship between intrinsic religiosity and risk for
clinical depression did not vary by gender. Women displayed higher levels intrinsic religiosity
than men. Men’s mean score on the Intrinsic Religiosity Scale was 2.03 while women’s was 2.27
(p < .001). However, higher scores on measures of religiousness do not mean that there are
stronger associations with mental health measures for women than for men (Krause, Ellison, &
Marcum, 2002).
Intrinsic Religiosity and Anxiety. The association between intrinsic religiosity and
number of anxiety symptoms did not vary by gender. The association between intrinsic
religiosity and risk for clinical anxiety did vary by gender; however, this interaction was no
One explanation for the lack of findings for the interaction of intrinsic religiosity by
gender in association with depression and anxiety may be that men and women extract about
equal benefit from intrinsic religiosity. Unlike organizational religiosity which involves service
attendance and participation in religious activities—social activities where women may excel—
intrinsic religiosity reflects the inward experience of religion. Because men may be less social
than women (Eagly & Crowly, 1986; Gilligan, 1982) they may not take advantage of the
activities and relationships provided by religious activity. On the other hand, men may be just as
adept as women at taking advantage of the more private and personal expressions of religion.
Interestingly, Idler (1987) found that men derived more benefit from private religiousness than
women and suggests that this reflects men’s preference for inward reflection for coping as
anxiety symptoms when moving from lower to higher levels of organizational religiosity. It
should be noted though, that despite this decline, religious women still reported comparable
levels of anxiety as religious men. Idler (1987) found that older women displayed a stronger
association between public religiousness and lower depression than older men did (though both
displayed significant associations). As already noted, this may reflect older women’s preference
Why might older women in particular draw more benefit from religious attendance and
participation? One possibility is that in late life women may have more time and maintain better
health than their male counterparts. As men retire, they may take over household duties which
leave women more time to participate in religious groups and services. Furthermore, in late life,
women may be less burdened by family obligations such as childcare, leaving them with more
time to invest in themselves. Women’s self-rating of their physical health tends to decline less
steeply than men’s in older adulthood (McCullough & Laurenceau, 2004) which may allow them
to be more active in religious services than men. For instance, women may be more likely to
serve as Eucharistic ministers at Catholic masses which requires one to stand on one’s feet for a
significant period of time and ascend and descend the alter several times.
anxiety symptoms, there were other interactions that trended toward significance (e.g., there was
a trend for the interaction between organizational religiosity and gender in association with
clinical depression). Consistent with prior work (McFarland, 2009), these trends suggest the
opposite interpretation: that men display a stronger association between higher religiousness and
improved mental health than do women. It is possible that future work might clarify the complex
92
relationship among religiousness, gender, and mental health in late life. It also possible that the
lack of a definitive pattern of results in prior studies and this dissertation may indicate that there
mental health.
The most salient limitation of this study is the sample size compared to other studies on
the same topic and the unique characteristics of study participants. This study included 143
participants. Many of the prior studies cited in this paper were composed of large
epidemiological samples. However, one advantage of this study is its measures of religiosity
which were well-validated multi-item scales as opposed to ad hoc single or double item
instruments.
This dissertation used a secondary data analysis. The data analyzed in this dissertation
were gathered in 1998 from older adults residing in the New York area. Therefore, the results of
this study cannot be generalized to older adults from other geographic areas. Furthermore, while
the original sample included a large number of Black participants, the current study was limited
to Caucasians. Thus, the results of this study cannot be generalized to minority populations.
While this sample consisted of community dwelling older adults, participants were
known to have recently experienced an important loss or other life transition. Because
participants were identified by need, rates of clinical depression and anxiety in this sample (55%
and 45%, respectively) are significantly higher than those typically observed in samples of
community dwelling older adults. For instance, depression rates among older adults range from
approximately 8-10% (Gurland, Cross, & Katz, 1996) and anxiety rates range from
approximately 5-20% (Himmelfarb & Murrell, 1984; Reiger, Boyd, Burke, Rae, Myers, Kramer,
93
et al., 1988). It is possible that participants’ recent loss may have influenced their reporting not
only of current levels of depression and anxiety but also religious variables.
Nevertheless, participants in this sample had not received psychotherapy in the last five
years and had no history of psychiatric disturbances. Bonnano (2004) notes that while most
people experience some disturbance in mood and functioning after a loss or other trauma,
humans tend to be highly resilient. Previous research using this sample has noted that, despite
being distressed, participants in this sample were all connected to others well enough that
someone noticed their distress and referred them to this study. Therefore, participants in this
study were functioning well enough that they remained involved in their communities (Grice,
1999). However, this same inclusion criteria (i.e., not having received psychotherapy or
counseling within the last five years) may have had an unintended consequence: a sample of
people who have avoided therapy. Caution should thus be used in generalizing these finding to
other groups.
Due to the cross-sectional design of this study, causality between variables cannot be
determined. The study findings only indicate relationships between variables. As a result, the
findings of this study should be viewed with caution and alternative explanations considered. For
number of anxiety symptoms. It is possible that higher organizational religiosity may lead people
to feel more guilt which in turn may result in higher anxiety. On the other hand, it is equally
possible that people higher in anxiety may have become more religiously active during times of
difficulty.
Religiosity variables were only moderately related to depression or anxiety. This is not
unexpected since the religiosity and interaction terms were entered in the last step of the model
94
and therefore forced to compete with demographic and resource variables for variance in the
depression and anxiety measures. Additionally, demographics and resources tend to account for
more variance in psychological distress than religiousness. Effect sizes for the association
between religiosity and mental health tend to be small to moderate (Cohen & Koenig, 2003).
Therefore, relative to demographic and resource predictors, the importance of religiousness for
differences observed between Christians and Jews, and men and women may have actually
indicated higher or lower levels of self-disclosure. This concern is especially salient for the
dependent variables in this study: depression and anxiety. Additionally, degree of self-disclosure
may have influenced reporting on resource variables included as controls such as perceived
health and personal efficacy. There is evidence that women may be more willing to disclose
details of physical illness and disease than men (Koray, Hibbard & Pope, 1983; Neighbors &
Furthermore, both Jews and women have been found to be more open to psychotherapy
(Farber & Geller, 1977) and display a higher tolerance for the stigma associated with mental
health (McGowan & Midlarsky, in press). While the interviews conducted during this study were
member of the mental health profession. Therefore, these same religion and gender patterns of
Christian and Jewish subgroups were not differentiated in study analyses. This is
problematic given that Christians and Jews vary widely in their practices and beliefs. For
instance, Catholic churches and services are very different from their Protestant counterparts.
95
Catholicism consists of an extensive iconography and churches are typically filled with statues,
paintings, and frescos. Protestant churches tend to be austere. Additionally, Catholic tradition
affirms belief in the transubstantiation (transformation of bread and wine into the body and blood
of Jesus), saints, and Pope while Protestantism focuses on scripture and a personal relationship
with God. Such differences may well influence how religious participation relates to mental
health. There is also significant variation among Jewish groups. For instance, Orthodox Jews
believe in a literal interpretation of the Torah, the coming of the Jewish messiah, and life after
death. In contrast, Reform and Conservative Jews use the Torah as an ethical and spiritual guide
but do not believe in its literal fulfillment. While observations during this study suggest that the
sample did not include a large number of Orthodox Jews, even a small number may have
introduced significant variation into measures of religiousness among Jewish participants in this
study.
Catholics and Orthodox Jews have more in common in many ways than Catholics have
with Protestants or Orthodox Jews have with Non-Orthodox Jews. Both require a belief in God
and ascribe to more conservative positions on issues such as abortion, homosexuality, and
euthanasia. Future work might explore how the relationship between religiousness and mental
health varies between Orthodox religious groups (i.e., Catholics and Orthodox Jews) and their
Finally, there may be unaccounted for variables which were not controlled for. For
instance, many of the Jews in this sample were not born in United States and some may have
come as refugees in the 1930s and 1940s. Therefore, the Jewish group in this study likely
included more non-native speaking and foreign-born participants than the Christian group.
96
Prior work has shown that higher religiousness is associated with better mental health but
this research has used primarily Christian samples. The results of this study provide evidence
that the association between religiousness and mental health may vary by religion. Future work
might focus exclusively on Jewish samples to determine how religiousness is associated with
mental health. Possible mediators for that relationship which might also explain its attenuation
compared to Christian samples include (1) degree to which worship facilitates emotional renewal
Given the number of studies which have explored the relationship between religiousness
and mental health, it is surprising that only one (Cohen, 2002) examined how this relationship
varies based upon participants’ religion. Koenig et al. (2001) noted that different religious beliefs
and practices may not display the same relationship with mental health, and called for research
exploring how beliefs and practices may be differentially associated with mental health for
Christians, Jews, Muslims, and other religious groups. Cohen’s (2002) paper provided empirical
evidence that spirituality, religious coping, and belief were more strongly related to happiness
and life satisfaction for Christians than for Jews. On the other hand, both groups displayed an
association between religious practice and life satisfaction. This dissertation is the first known
study of how the relationship between religiousness and psychopathology varies by religious
affiliation. Future studies of mental health outcomes including both Christians and Jews, or
members of other traditions such as Islam, should include religious affiliation as a control
variable.
As noted in the limitations, this study does not differentiate between Christian and Jewish
subgroups. Indeed, in Judaism there are significant differences in religious belief and behavior
97
among Reform, Conservative, and Orthodox Jews. For Christians, not only are there salient
differences between Catholics and Protestants, but also differences within these groups. Another
fruitful line of inquiry may be the study of insular Christian and Jewish groups which would
likely demonstrate more homogeneity on measures of religious belief and practice and allow for
This dissertation may have implications for the development of alternative measures of
religiousness. The Intrinsic Religiosity Scale used herein was developed using a sample of
Protestant, mostly Presbyterian, adults. As noted earlier, some items on the scale can be
interpreted in different ways. For some groups, the notion of living their religion may indicate
adherence to religious law (Orthodox Jews), while for others it may indicate a personal
relationship with God (Protestant Christians). This distinction becomes especially salient when
This is the third known study to explore gender differences in the association between
religiousness and mental health in late life. Findings herein revealed that older women show a
steep decline in anxiety as they become more religious while older men do not. However, there
were also trends suggesting men display a stronger association between religiousness and better
mental health as also indicated by McFarland (2009). Future work may be useful in clarifying the
relationships among gender, religiousness, and mental health. However, evidence so far does not
This dissertation may also have implications for clinicians working with religious
patients, especially older adults. Given that this study found a stronger association between
higher levels of religiousness and lower depression for Christians, Christian patients might be
encouraged when appropriate to take up religious activity for therapeutic benefit. For instance,
98
behavioral activation (Carver & White, 1994) is an empirically supported cognitive behavioral
therapy technique that encourages depressed patients to spend more time doing what they enjoy.
Increasing religious activity may pay significant dividends for Christians suffering from
Conclusion
This study found that Christians displayed higher levels of intrinsic religiosity than Jews
but not organizational religiosity. There was also limited evidence that women display higher
levels of intrinsic religiosity than men. People higher in organizational religiosity reported a
higher number of anxiety symptoms. This was unexpected given the vast number of studies
showing that more religious people have better mental health than their less religious
counterparts. Consistent with predictions, Jews displayed a higher risk for clinical anxiety than
Christians, and women displayed higher levels of depression and anxiety than men. Religious
affiliation and gender differences emerged in the relationship between religiousness and mental
health. Christians displayed a stronger inverse association between organizational religiosity and
depression. Less religious women displayed higher levels of anxiety than less religious men, but
men and women did not differ in anxiety when higher in religiousness.
99
REFERENCES
Adelbratt, S. & Strang, P. (2000). Death anxiety in brain tumour patients and their spouses.
Palliative Medicine, 14(6), 499-507.
Addis, M. & Mahalik, J. (2003). Men, masculinity, and the contexts of help-seeking. American
Psychologist, 58(1), 5-14.
Aiken, L.& West, S. (1991). Multiple regression: Testing and interpreting interactions.
Thousand Oaks, CA: Sage.
Allport, G. & Ross, J. (1967). Personal religious orientation and prejudice. Journal of
Personality and Social Psychology, 5, 432-443.
Ano, G. & Vasconcelles, E. (2005). Religious coping and psychological adjustment to stress: A
meta-analysis. Journal of Clinical Psychology, 61(4) 461-480.
Anti-defamation League (2009). Poll: Anti-Semitic attitudes match lowest level recorded;
targeting of Jews for violence and blame continues. Retrieved July 15, 2011 from:
http://www.adl.org/PresRele/ASUS_12/5633_12.htm
Ariel, D. (1995). What do Jews believe? The spiritual foundations of Judaism. New York:
Schocken Books.
Ash, A., Carr, P., Goldstein, R., & Friedman, R. (2004). Compensation and advancement in
academic medicine: Is there equity? Annals of Internal Medicine, 141(3), 205-212.
Batson, C., Schoenrade, P., & Ventis, W. (1993). Religion and the individual: A Social-
psychological Perspective. New York: Oxford University Press.
Beard, M., North, J., & Price, S. (1998). Religion of Rome: Vol. 1: A history. Cambridge:
Cambridge University Press.
Beit-Hallahmi, B., & Argyle, M. (1997). The psychology of religious behavior, belief, and
experience: The effect of age and socioeconomic status. Journal of Gerontology: Social
Science, 60B, 311-317.
100
Belle, D. (1990). Poverty and women’s mental health. American Psychologist, 45(3), 385-389.
Berle, D. & Starcevic, V. (2005). Thought-action fusion: Review of the literature and future
directions. Clinical Psychology Review, 25(3), 263-284.
Berger, P. (1967). The sacred canopy: Elements of a sociological theory of religion. Garden City,
NY: Anchor.
Blanchard-Fields, F. & Irion, J. (1988). The relation between locus of control and coping in two
contexts: Age as moderator variable. Psychology and Aging, 3, 197-203.
Bonanno, G. (2004). Loss, trauma, and human resilience: have we underestimated the human
capacity to thrive after aversive events? American Psychologist, 59(1), 20-28.
Bosworth, H., Park, K., McQuoid, D., Hays, J., & Steffens, D. (2003). The impact of religious
practice and religious copings on geriatric depression. International Journal of Geriatric
Psychiatry, 18, 905-914.
Braam, A., Beekman, A., Deeg, D., & van Tilburg, W. (1997). Religiosity as a protective or
prognostic factor of depression in late life: Results from a community survey in The
Netherlands. Acta Psychiatrica Scandinavica, 96, 199-205.
Bremner, J., Southwick, S., Johnson, D., Yehuda, R., & Charney, D. (1993). Childhood physical
abuse and combat-related posttraumatic stress disorder in Vietnam veterans. American
Journal of Psychiatry, 150, 235-239.
Carver, C. & White. T. (1994). Behavioral inhibition, behavioral activation, and affective
responses to impending reward and punishment, Journal of Personality and Social
Psychology, 67(2), 319-333.
Chatters, L., Levin, J. & Taylor, R. (1992). Antecedents and dimensions of religious
involvement among older Black adults. Journal of Gerontology: Social Sciences, 47,
S183-S189.
Cohen, A. (2002). The importance of spirituality in well-being for Jews and Christians. Journal
of Happiness Studies, 3, 287-310.
Cohen, A., Hall, D., Koenig, H., & Meador., K. (2005). Social versus individual motivation:
implications for normative definitions of religious orientation. Personality and Social
Psychology Review, 9(1), 48-61.
Cohen, A. & Hall, P. (2007). Religion as culture: religious individualism and collectivism among
American Catholics, Jews, and Protestants. Journal of Personality, 75(4), 709-742.
Cohen, A. & Koenig, H. (2003). Religion, religiosity, and spirituality in the biopsychosocial
model of health and ageing. Ageing International, 28(3), 215-241.
101
Cohen, A., Malka, A., Rozin, & Chefras, L. (2006). Religion and unforgivable offenses. Journal
of Personality, 74, 85-118.
Cohen, A., & Rozin, P. (2001). Religion and the morality of mentality. Journal of Personality
and Social Psychology, 81, 697-710.
Cohen, A., Siegel, J., & Rozin, P. (2003). Faith versus practice: different bases for religiosity
judgments by Jews and Protestants. European Journal of Social Psychology, 33(2), 287-
295.
Cole, M. & Dendukuri, N. (2003). Risk factors for depression among elderly community subjects:
a systematic review and meta-analysis. American Journal of Psychiatry, 160, 1147-1156.
Colucci, E., & Martin, G. (2008). Religion and spirituality along the suicidal path. Suicide and
Life-Threatening Behavior, 38, 229-244.
Conte, H., Weiner, M., & Plutchik, R. (1982). Measuring death anxiety: Conceptual,
psychometric, and factor analytic aspects. Journal of Personality and Social Psychology,
43(4), 775-785.
Cooklin, R., Ravindran, A. & Carney, M. (1983). The patterns of mental disorder in Jewish and
non-Jewish admissions to a district general hospital psychiatric unit: is manic depressive
illness a typically Jewish disorder? Psychological Medicine, 13, 209-212.
Courtney, B., Poon, L., Martin, P., Clayton, G., & Johnson, M. (1992). Religiosity and
adaptation in the oldest-old. International Journal of Aging and Human Development, 34,
47-56.
Dabbs, J., & Morris, R. (1990). Testosterone, social class, and anti-social behavior in a sample of
4,462 men. Psychological Science, 1, 209-211.
Dattell, A. & Niemeyer, R. (1990). Sex differences in death anxiety: Testing the emotional
expressiveness hypothesis. Death Studies, 14(1), 1-11.
Davis, T., Kerr, B., & Kurpuis, S. (2003). Meaning, purpose, and religiosity in at-risk youth:
The relationship between anxiety and spirituality. The Journal of Psychology and
Theology, 31(4), 356-365.
Derogatis, L. (1993). Brief Symptom Inventory (BSI): Administration, scoring, and procedures
manual. 3rd ed. Minneapolis: National Computer Systems.
Derogatis, L., & Spencer, P. (1982). The Brief Symptom Inventory (BSI): Administration,
scoring, and procedure manual. Clinical Psychometric Research: Baltimore.
102
Dillon, M. & Wink, P. (2007). In the course of a lifetime: Tracing religious belief, practice, and
change. Berkley, CA: University of California Press.
Dixon, R. & Kinlaw, B. (1982-1983). Belief in the existence and nature of life after death: A
research note. Omega: Journal of Death and Dying, 13, 287-292.
Dubow, E., Pargament, K., Boxer, P., & Tarakeshwar, N. (2002). Initial investigation of Jewish
early adolescents’ ethnic identity, stress, and coping. Journal of Early Adolescence, 20,
418-441.
Dunn, O. (1961). Multiple comparisons among means, Journal of the American Statistical
Association, 56, 52-64.
Eagly, A. & Crowley, M. (1986). Gender and helping behavior: a meta-analytic review of the
social psychology literature. Psychological Bulletin, 100, 283-308.
Ellis, A. (1987) Religiosity and emotional disturbance: A reply to Sharkey and Maloney.
Psychotherapy, 24, 826-827.
Ellison, C., Finch, B., Ryan, D., & Salinas, J. (2009). Religious involvement and
depressive symptoms among Mexican-origin adults in California. Journal of Community
Psychology, 37(2), 171-193.
Ellison, C. (1994). Religion, the life stress paradigm, and the study of depression. In J.S. Levine
(Ed), Religion in aging and health: Theoretical foundations and methodological frontiers
(78-121). Thousand Oaks, CA. Sage.
Ellison, C. & George, L. (1994). Religious involvement, social ties, and social support in a
southeastern community. Journal for the Scientific Study of Religion, 33, 46-61.
Erikson, E. (1959). Identity and the lifecycle: Selected papers. Psychological Issues, 1,
1-171.
Feldman, S., Fisher, Ransom, D., & Dimiceli, S. (1995). Is “what is good for the goose, good for
the gander?” Sex differences in relations between adolescent coping and adult adaptation.
Journal of Research on Adolescence, 5, 333-359.
Fehring, R., Miller, J., & Shaw, C. (1997). Spiritual well-being, religiosity, hope, depression, and
other mood states in elderly people coping with cancer. Oncology Nursing Forum, 24,
663-671.
103
Ferraro, K., & Kelley-Moore, J. (2000). Religious consolation among men and women: Do
health problems spur help-seeking? Journal for the Scientific Study of Religion, 39, 220-
234.
Filmore, K. (1987). Prevalence, incidence and chronicity of drinking patterns and problems
among men as a function of age: a longitudinal and cohort analysis. British Journal of
Addition, 82(1), 77-83.
Fiori, K. Brown, E., Cortina, K., & Antonucci, T. (2006). Locus of control as a mediator of the
relationship between religiosity and life satisfaction: Age, race, and gender differences.
Mental Health, Religion, and Culture, 9(3), 239-263.
Firsch, M., Cornell, J., Villanueva, M., & Retzlaff, P. (1992). Clinical validation of the Quality
of Life Inventory. A measure of life satisfaction for use in treatment planning and
outcome assessment. Psychological Assessment, 4(1), 92-101.
Flint, A.J. (1994). Epidemiology and comorbidity of anxiety disorder in the elderly.
American Journal of Psychiatry, 151, 640-649.
Flom, P. & Strauss, S. (2003). Some graphical methods for interpreting interactions in logistic
and OLS regression. Multiple Linear Regression Viewpoints, 29(1), 1-7.
Fox, E. (1989/1939). The sermon on the mount. The key to success in life. San Francisco, Harper
Collins.
Francis, L. & Wilcox, C. (1996). Religion and gender orientation. Personality and Individual
Differences, 20, 119-121.
Gallup poll. (2008). Belief in God Far Lower in Western U.S. Princeton, N.J. Princeton
Religious Research Center. Retrieved September 24, 2010 from:
http://www.gallup.com/poll/109108/belief-god-far-lower-western-us.aspx
Gallup poll. (2002). Religion and gender: A congregation divided. Washington, D.C. Retrieved
September 24, 2010 from http://www.gallup.com/poll/7336/religion-gender-
congregation-divided.aspx
104
George, L., Ellison, C., & Larson, D. (2002). Explaining relationships between religious
involvement and health. Psychological Inquiry, 13, 190-200.
Gillum, R. (2005). Frequency of attendance at religious services and cigarette smoking American
women and men: The Third National Health and Nutrition Examination Survey.
Preventative Medicine, 41(2), 607-613.
Glass, G. & Hopkins, K. (1984).Statistical methods in education and psychology. Prentice Hall,
Englewood Cliffs, NJ.
Glicksman, A. (1991). The new Jewish elderly. American Jewish Committee, New York, NY.
Goldberg, D., & Williams, P. (1988) A user’s guide to the General Health Questionnaire.
Windsor: NFER-Nelson.
Goodwin, R. & Gotlib, I. (2004). Gender differences in depression: the role of personality factors.
Psychiatry Research, 126(2), 135-142.
Gorman, J. (1997). Comorbid depressin and anxiety spectrum disorder. Depression and Anxiety,
4, 160-168.
Gottfredson, M. & Hirschi, T. (1990). A general theory of crime. Stanford, CA. Stanford
University Press.
Gove, W. (1984). Gender differences in mental and physical illness: The effects of fixed roles
and nurturant roles. Social Science and Medicine, 19(2), 77-84.
Gregory, F. (2001). Racial differences in the association between religiosity and psychological
Distress. Unpublished doctoral dissertation, Teachers College, Columbia University,
New York, NY.
Grice, M. (1999). Attachment, race, and gender in late life: relationships to depression, anxiety,
and self-efficacy. Unpublished doctoral dissertation, Teachers College, Columbia
University, New York, NY.
Gurland, B., Cross, P., & Katz, S. (1996). Epidemiological perspectives on opportunities for
treatment of depression. American Journal of Geriatric Psychiatry, 4(1), S7-S13.
Hackney, C., & Sanders, G. (2003). Religiosity and mental health: A meta-analysis of recent
studies. Journal for the Scientific Study of Religion, 42(1) 43-55.
105
Hadas, A. & Midlarsky, E. (2000). Perceptions of responsibility and mental health help-seeking
among psychologically distressed older adults. Journal of Clinical Psychology, 6(3), 175-
185.
Hale, D., Cochran, C., & Hedgepeth, B. (1984). Norms for the elderly on the Brief Symptom
Inventory. Journal of Consulting and Clinical Psychology, 52(2), 321-322.
Harding, S., Flannelly, K., Weaver, A., & Costa, K. (2005). The influence of religion of death
anxiety and death acceptance. Mental Health, Religion, and Culture, 8(4), 253-261.
Harrison, M., Koenig, H., Hays, J., Eme-Akwari, A., & Pargament, K. (2001). The epidemiology
of religious coping: a review of the literature. International Review of Psychiatry, 13, 86-
93.
Headey, B., Kelley, J., & Wearing, A. (1993). Dimensions of mental health: Life Satisfaction,
positive affect, anxiety, and depression. Social Indicators Research, 29(1), 63-82.
Henretta, J. (2001). The future of age integration in employment. The Gerontologist, 40, 286-292.
Hibbard, J. & Pope, C. (1983). Gender roles, illness orientation, and use of medical services.
Social Science and Medicine, 17, 129-137.
Hill, T., Ellison, C., Burdette, A., & Musick, A. (2007). Religious involvement and healthy
Lifestyles: evidence from the survey of Texas adults. Annals of Behavioral Medicine,
34(2), 217-222.
Hill, T. & McCullough, M. (2007). Religious involvement and the intoxication trajectories of
low-income urban women. Journal of Drug Issues, 38, 847-862.
Hill, P., & Pargament, K. (2003). Advances in the conceptualization and measurement of
religion and spirituality. American Psychologist, 58(1), 64-74.
Himmelfarb, S. & Murrell, S. (1984). The prevalence and correlates of anxiety in older adults.
The Journal of Psychology, 116, 159-167.
Hintikka, J., Koskela, K., Kontula, O., & Viinamäki, H. (2000). Gender differences in
associations between religious attendance and mental health in Finland. Journal of
Nervous and Mental Disease, 188(1), 772-776.
Hermesh, H., Masser-Kavitzky, R., & Gross-Isseroff, R. (2003). Obsessive compulsive disorder
and Jewish identity. Journal of Nervous and Mental Disease, 191(3), 201-203.
Heyer-Grey, Z. (2000). Gender and religious work. Sociology of Religion, 61, 467-471.
Hoge, D. R. (1972). A validated intrinsic religiosity scale. Journal for the Scientific Study
of Religion. 11(4), 369-376.
106
Hooker, K., Monahan, D., Shifren, K., Hutchinson, C. (1992). Mental and physical health of
spouse caregivers: the role of personality. Psychology and Aging, 7(3), 367-375.
Idler, E. (1995). Religion, health, and nonphysical senses of self. Social Forces, 74(2), 683-704.
Idler, E. (1987). Religious involvement and the health of the elderly: Some hypotheses and an
initial test. Social Forces, 66, 226- 238.
Idler, E. & Kasl, S. (1991). Health perceptions and survival: Do global evaluations of health and
status really predict mortality? Journal of Gerontology: Social Sciences, 46, S55-65.
Cited in Hooker, K., Monahan, D., Shifren, K., Hutchinson, C. (1992). Mental and
physical health Of spouse caregivers: the role of personality. Psychology and Aging, 7(3),
367-375.
Jacobson, C. & Heaton, T. (1990). Black-White differences in religiosity: Item analyses and a
formal structural test. Sociology of Religion, 51(3), 257-270.
Kaplan, G. & Camacho, T. (1983). Perceived health and mortality. A nine-year follow-up of the
human population laboratory cohort. American Journal of Epidemiology, 117, 292-304.
Cited in Hooker, K., Monahan, D., Shifren, K., Hutchinson, C. (1992). Mental and
physical health Of spouse caregivers: the role of personality. Psychology and Aging, 7(3),
367-375.
Kendler, K., Gardner, C., & Prescott, C. (1997). Religion, psychopathology, and substance use
and abuse. A multimeasure, genetic-epidemiological study. American Journal of
Psychiatry, 154, 32-329.
Kennedy, G., Kelman, H., Thomas, C., & Chen, J. (1996). The relation of religious preference
and practice to depressive symptoms among 1,855 older adults. Journal of Gerontology:
Psychological Sciences, 51B, 301-308.
Kessler, R., Demler, O., Frank, R., Olfson, M., Pincus, H., Walters, E. et al., (2005). Prevalence
and treatment of mental disorder, 1990 – 2003. New England Journal of Medicine, 352,
2515-2523.
Kessler, R. & McLeod, J. (1984). Sex differences in vulnerability to undesirable life events.
American Sociological Review, 49(5), 620-631.
Kessler, R., Price, R., & Wortman, C. (1985). Social factors in psychopathology: Stress, social
support, and coping processes. Annual Review of Psychology, 36, 531-572.
Kirkpatrick, L. (2004). Attachment, evolution, and the psychology of religion. New York,
Guilford Press.
107
Kirkpatrick, L. & Hood, R. (1990). Intrinsic-extrinsic religious orientation: The boon or bane of
contemporary psychology of religion. Journal for the Scientific Study of Religion, 29,
442-462.
Kishon-Barash, R, Midlarsky, E., & Johnson, D. (1999). Altruism and the Vietnam War veteran:
the relationship of helping to symptomatology. Journal of Traumatic Stress, 12(4), 655-
662.
Kenlow, D. & Bolin, R. (1989-1990). Belief in an afterlife: a national survey. Omega: Journal
of Death and Dying, 20, 63-74.
Koenig, H. (2001). Religion and medicine II: Religion, mental health, and related behaviors.
International Journal of Psychiatry and Medicine, 31(1), 97-109.
Koenig, H. (1994). Religion and hope for the disturbed elder. In Levin, J.S. ed. Religion in Aging
and Health. Thousand Oaks, California, Sage Publications. 18-51.
Koenig, H., Cohen, H., & Blazer, D. (1992). Religious coping and depression in elderly
hospitalized medically ill men. American Journal of Psychiatry, 149, 1693-1700.
Koenig, H., Cohen, H., & Blazer, D. (1995). Cognitive symptoms of depression and religious
coping in elderly medical patients. Psychosomatics, 36, 369-375.
Koenig, H., Cohen, H., Blazer, D., Pieper, C., Meador, K., Shelp, F. et al (1992). Religious
coping and depression in elderly hospitalized medically ill men. American Journal of
Psychiatry, 149, 1693-4700.
Koenig, H., Ford., S., George, L, Blazer, D, & Meador, K. (1993). Religion and anxiety
Disorder: An examination and comparison of associations in young, middle-aged, and
elderly adults. Journal of Anxiety Disorders, 7(4) 321-340.
Koenig, H. & Futterman, A. (1995). Religion and health outcomes: A review and synthesis of the
literature. Proceedings of the NIH Conference on Methodological Approaches to the
Study of Religion, Aging, and Health. Bethesda, MD, March 16-17.
Koenig, H., George, L., Meador, K, Blazer, D. & Ford, S. (1994). The relationship between
religion and alcoholism in a sample of community dwelling adults. Hospital and
Community Psychiatry, 45, 586-596.
Koenig, H., George, L., & Peterson, B. (1998). Religiosity and remission of depression in
medically ill older patients. American Journal of Psychiatry, 155, 536-542.
Koenig, H., Hays, J., George, L., Blazer, D., Larson, D., & Landerman, L. (1997). Modeling the
cross-sectional relationships between religion, physical health, social support, and
depressive symptoms. The American Journal of Geriatric Psychiatry, 5(2), 131-143.
108
Koenig, H., Kvale, J., & Ferrel, C. (1998). Religion and well-being later in life. The
Gerontologist, 28, 18-28.
Koenig, H., Meader, K., & Parkerson, G. (1997). Religion index for psychiatric research: a 5-
item measure for use in health outcome studies. American Journal of Psychiatry, 154,
885-886.
Koenig, H., McCullough, M., & Larson, D. (2001). Handbook of religion and health. New York:
Oxford, University Press.
Koenig, H., Smiley, M. & Gonzalez, J. (1988). Religion, health, and aging: A review
and theoretical integration. New York: Greenwood Press.
Krause, N. (2008). Aging in the church: How social relationships affect health. West
Conshohocken, PA: Templeton Foundation Press.
Krause, N. (2003). Religious meaning and subjective well-being in late life. Journal of
Gerontology: Social Sciences, 58B, S160-S170.
Krause, N., Ellison, C., & Marcum, J. (2002). The effects of church-based emotional support on
health: Do they vary by gender? Sociology of Religion, 63, 21-47.
Krause, N., & Tran, T. (1989). Stress and religious involvement among older blacks. Journal of
Gerontology, 44, 4-13.
Kushner, H. (1994). To life! A celebration of Jewish being and thinking. NY: Little, Brown, and
Company.
Lamm, M. (2000). Jewish way in death and mourning. Middle Village, NY: Jonathan David
Publishers.
Lang, A. (2003). Brief intervention for co-occurring anxiety and depression in primary care: a
pilot study. The International Journal of Psychiatry in Medicine, 33(2), 141-154.
Levant, R. & Pollack, W. (1995). The new psychology of men. New York, NY: Basic Books.
Levav, I., Kohn, R., Golding, J., & Weissman, M. (1997). Vulnerability of Jews to affective
disorders. American Journal of Psychiatry, 154, 941-947.
Levin, J., Taylor, R., & Chatters, L. (1995). Race and gender differences in religiosity among
older adults: Findings from four national surveys. The Journal of Gerontology, 49(3),
137-145.
Levin, J., & Vanderpool, H. (1989). Is religion therapeutically significant for hypertension?
Social Science and Medicine, 29, 69-78.
Levin, J., & Vanderpool, H (1987). Is frequent religious attendance really conducive to better
health?: Toward an epidemiology of religion. Social Science & Medicine, 24(7), 589-600.
Lewis, C., Shevlin, M., Francis, L., Quigley, C. (2010). The association between church
attendance and psychological health in Northern Ireland: a national representative
survey among adults allowing for sex differences and denominational difference. Journal
of Religion and Health, 10, 1007/s109-43-010-9321-3. Retrieved from: http://www.ncbi.
nlm.nih.gov/pubmed/20108121
Leach, L, Christensen, A., Mackinnon, T., Windsor, T., & Butterworth, P. (2008). Gender
differences in depression and anxiety across the adult lifespan: the role of psychosocial
mediators. Social Psychiatry and Psychiatric Epidemiology, 43(12), 983-998.
Liang, J., Dvorkin, L., Kahana, E., & Mazian, F. (1980). Social integration and morale: a re-
examination. The Gerontologist, 35(5), 746-757.
Lubben, J. (1988). Assessing social networks among elderly populations. Family and
Community Health, 11(3), 42-52.
Maimonides, M. (12 Century/1967). Mishneh Torah. New York: Hebrew Publishing Company.
Mahalik, J. & Lagan, H. (2001). Examining masculine gender role conflict and stress in relation
to religious orientation and spiritual well-being. Psychology of Men and Masculinity,
2(1), 24-33.
Malzberg, B. (1973). Mental disease among Jews in New York State: 1960-1961. Acta
Psychiatrica Scandinavica, 49, 479-518.
Matthews, D., Larson, D., & Barry, C. (1993). The faith factor: an annotated bibliography of
clinical research on spiritual subjects, Vol. 1. Rockville, MD: National Institute for
Healthcare Research.
Maton, K. (1989). The stress-buffering role of spiritual support: Cross-sectional and prospective
investigations. Journal for the Scientific Study of Religion, 28(3), 310-323.
110
McCullough, M., & Larson, D. (1999). Religion and depression: a review of the literature. Twin
Research, 2(2), 126-136.
McCullough, M. & Laurenceau, J. (2004). Gender and the natural history of self-rated health: A
59-year longitudinal study. Heath Psychology, 23(6), 651-655.
McFarland, M. (2009). Religion and mental health among older adults: do the effects of religious
involvement vary by gender? Journal of Gerontology, Social Sciences, 65B(5), 621-630.
McGowan, J., & Midlarsky, E. (in press) Religiosity, authoritarianism, and attitudes
toward psychotherapy in late life. Aging and Mental Health
McLynn, F. (1997). Carl Gustav Jung: A biography. New York, N.Y. Thomas Dunne Books.
Meertens, V., Scheepers, P., & Tax, B. (2003). Depressive symptoms in the Netherlands 1975-
1996: A theoretical framework and an empirical analysis of socio-demographic
characteristics, gender differences and changes over time. Sociology of Health and
Fitness, 25, 208-321.
Miller, A. & Hoffman, J. (1995). Risk and religion: An explanation of gender differences in
religiosity. Journal for the Scientific Study of Religion, 34, 63-75.
Miller, A. & Stark, R. (2002). Gender and religiousness: Can socialization explanations be
saved? American Journal of Sociology, 107, 1399-1423.
Milstein, G., Bruce, M., Gargon, N., Brown, E., Raue, P., & McAvay, G. (2003). Religious
practice and depression among geriatric home care patients. International Journal of
Psychiatry and Medicine, 33, 71-83.
Mirola, W. (1999). A refuge for some: gender differences in the relationship between religious
involvement and depression. Sociology of Religion, 60(4), 419-437.
Mirowsky, J. (1995). Age and the sense of control. Social Psychology Quarterly, 58, 31-43.
Mirowsky, J. & Reynolds, J. (2000). Age, depression, and attrition in the National Survey of
Families and Households. Sociological Methods & Research, 28, 476-504.
Morris, P. (1996). Community beyond traditions. In P. Heelas, S. Lash & Morris (Eds),
Detraditionalization: Critical reflections on authority and identity (222-249). Cambridge:
Blackwell.
Neighbors, H. & Howard, C. (1987). Sex differences in professional help seeking among adult
Black Americans. American Journal of Community Psychology, 15, 403-417.
Nemeroff, R. & Midlarsky, E. (2000). Gender and racial correlates of personal control among
emotionally disturbed older adults. The International Journal of Aging and Human
Development, 50(1), 1-15.
Neusner, J. (1993). Judaism, in A. Sharam (ed), Our Religions. Harper San Francisco: San
Francisco. 293-355.
Norenzayan, A. & Hansen, I. (2006). Belief in supernatural agents in the face of death.
Personality and Social Psychology Bulletin, 32, 174-187.
Norton, M., Skoog, I., Franklin, L., Corcoran, C., Tschanz, J., Zandi, P., et al. (2006)
Gender differences in the association between religious involvement and depression: the
Cache County (Utah) Study. Journal of Gerontology: Psychological Sciences, 61B(3),
129-136.
Pargament, K., Smith, B., Koenig, H., Perez, L. (1998). Patterns of positive and negative
religious coping with major life stressors. Journal for the Scientific Study of Religion, 37,
710-724.
Pargament, K. (1997). The psychology of religion and coping: Theory, research, and practice.
New York, Guilford Press.
Pavot, W. & Diener, E. (1993). Review of the Satisfaction With Life Scale. Psychological
Assessment, 5(2), 164-172.
Pennix, B., Leveille, S., Ferucci, L., van Eijk, J., & Guralink, J. (1999). Exploring the effect of
depression on physical disability: Longitudinal evidence from the established population
for epidemiologic studies of the elderly. American Journal of Public Health, 89, 134-
1352.
Pearlin, L., Meneghan, E., Lieberman, M., & Mullan, J. (1981). The stress process. Journal of
Health and Social Behavior, 22, 337-356.
Pearlin, L. & Schooler, C. (1978). The structure of coping. Journal of Health and Social
Behavior, 19, 2-21.
Pew Survey. (2010). Religion among the millennials. Washington, D.C. Pew Forum
on Religion and Public Life. Retrieved September 24, 2010 from:
http://pewforum.org/Age/Religion-Among-the-Millennials.aspx
112
Pew Survey. (2008). U.S. Religious Landscape Survey. Washington, D.C. Pew Forum on
Religion and Public Life. Retrieved September 24, 2010 from: hhttp://religions.pewforum.
org/portraits
Piccinelli, M. & Wilkinson, G. (2000). Gender differences in depression: a critical review. The
British Journal of Psychiatry, 177, 487-492.
Prager, D. & Telushkin, J. (1981). Nine questions people ask about Judaism. New York: Simon
& Schuster.
Pressman, P., Lyons, J., Larson, D., & Strain, J. (1990). Religious belief, depression and
ambulation status in elderly women with broken hips. American Journal of Psychiatry,
147, 758-760.
Prince, M., Beekman, A., Deeg, D., Fuhrer, R., Kivela, S., Lawlor, B. et al. (1999). Depression
symptoms in late life assessed using the EURO-D scale: Effects of age, gender, marital
status in 14 European Centres. British Journal of Psychiatry, 174, 339-345.
Rasmussen, C. & Johnson, M. (1994). Spirituality and religiosity: Relative relationships to death
anxiety. Journal of Death and Dying, 29(4), 313-318.
Reiger, D., Boyd, J., Burke, J., Rae, D., Myers, J., Kramer, M., et al. (1988). One-month
prevalence of mental disorders in the United States. Archives of General Psychology, 45,
977-986.
Roberts, R. & O’Keefe, S. (1981). Sex differences in depression reexamined. Journal of Health
and Social Behavior, 22, 394-406.
Robins, L., Helzer, J., Croughan, J., & Ratcliff, K. (1981). National Institute of Mental Health
Diagnostic Interview Schedule. Its history, characteristics, and validity. Archives of
General Psychiatry, 39, 381-389.
Rosmarin, D., Pargament, K., Krumrei, E., & Flannelly, K. (2009). Religious coping among
Jews: development and initial validation of the JCOPE. Journal of Clinical Psychology,
65(7), 670-683.
Ross, C. (1990). Religion and psychological distress. Journal for the Scientific Study of Religion,
29(2), 236-245.
113
Safren, S., Gershuny, B., & Hendrikson, E. (2003). Symptoms of posttraumatic stress disorder
in persons with HIV and medication adherence difficulties. AIDS Patient Care and STDs,
17(12), 657-664.
Sarason, I., Levine, H., Basham, R., & Sarason, B. (1983). Assessing social support: The social
support questionnaire. Journal of Personality and Social Psychology, 44(1), 127-139.
Sarason, I. & Shearin, E. (1986). The Short Form of the Social Support Questionnaire.
Unpublished manuscript. University of Washington: Seattle. Cited in Sarason, B.,
Shearin, E., Pierce, G., & Sarason, I. (1987). Interrelations of Social Support Measures:
Theoretical and Practical Implications. Journal of Personality and Social Psychology,
52(4), 813-832.
Schafer, W. (1997). Religiosity, spirituality, and personal distress among college students.
Journal of College Student Development, 38(6), 633-644.
Siev, J. & Cohen, A. (2007). Is thought action fusion related to religiosity? Differences between
Christians and Jews. Behavior Research and Therapy, 45(4), 829-837.
Silverstein, B. (1999). Gender differences in the prevalence of clinical depression: The role
played by depression associated with somatic symptoms. American Journal of Psychiatry,
156, 480-482.
Stark, R. (2002). Physiology and Faith: Addressing the “Universal” gender differences in
religious commitment. Journal for the Scientific Study of Religion, 41(3), 495-507.
Stark, R. (1996). The rise of Christianity. Princeton, N.J. Princeton University Press.
Strawbridge, W., Shema, S., Cohen, R., & Kaplan, G. (2001). Religious attendance increases
survival by improving and maintaining good health behaviors, mental health, and social
relationships. Annals of Behavioral Medicine, 23(1), 68-74.
Suter, L. (1973). Income differences between men and career women. American Journal of
Sociology, 78(4), 962-974.
Tanfer, K, Cubbins, L., & Billy, J. (1995). Gender, race, class, and self-reported sexually
transmitted disease incidence. Family Planning Perspectives, 27(5), 196-202.
Templin, D. & Martin, M. (1999). The relationship between religious orientation, gender, and
Drinking patterns among Catholic college students. College Student Journal, 33(4), 488-
496.
114
Turner, R. & Noh, S. (1988). Physical disability and depression: A longitudinal analysis.
Journal of Health and Social Behavior, 29, 23-27.
U.S. Bureau of the Census (2000). Retrieved August 31, 2009, from:
http://www.census.gov/population/projections/nation/summary/np-t3-b.pdf [On-line]
van Megen, H., den Boer-Wolters, D., & Verhagen, P. (2010). Obsessive compulsive disorder
and religion: A reconnaissance. In Verhagen, P., van Praag, H., Lopez-Ibor Jr., J., Cox, J.,
& Moussaoui, D (eds), Religion and Psychiatry: Beyond Boundaries. John Wiley & Sons,
West Sussex, UK.
Waters, W. (1992). Deadly doctrine: health, illness, and Christian God-talk. Buffalo, NY.
Prometheus Books.
Wex, M. (2005). Born to kvetch: Yiddish language and culture in all its moods. New York: St.
Martin’s Press.
Whitehead, K. (2009). Sacrosanctum Concilium and the Reform of the Liturgy: Proceedings
From the 29th annual fellowship of Catholic scholars. Scranton, PA. University of
Scranton Press.
Williams, K. (2003). Has the future of marriage arrived? A contemporary examination of gender,
marriage, and psychological well-being. Journal of Health and Social Behavior, 44, 470-
487.
Williamson, G. & Schulz, R. (1992). Pain, activity restriction, and symptoms of depression
among community-residing elderly adults. Journal of Gerontology, 47, 367-372.
Woodruff, S. & Cashman, J. (1993). Task, domain, and general efficacy: A reexamination of the
self-efficacy scale. Psychological Reports, 72, 423-432.
Wuthnow, R. (1994). Sharing the journey: Support groups and America’s new quest for
community. New York: Free Press.
Zedek, M. (1998). Religion and mental health from the Jewish perspective. In H.G. Koenig (ed),
Handbook of Religion and Mental Health (255-261). Academic Press: San Diego.
Zock, H. (1997). The predominance of the feminine sexual mode in religion: Erikson’s
contribution to the sex and gender debate in the psychology of religion. International
Journal for the Psychology of Religion, 7, 187-198.
115
APPENDICES
Appendix A
Demographic Questionnaire
2. Race: (1) White (2) Black (3) Hispanic (4) Asian (5) Other (Rated by interviewer)
4. What is your current religious preference? (1) Protestant (2) Catholic (3) Jewish (4) None (5)
5. Are you: (1) Married (2) Widowed (3) Divorced (4) Separated (5) Never married (9) Missing
6. At this time with whom are you living? (1) Alone (2) With spouse (3) With child or children
(4) With other family member (5) With a non-relative (6) Other or combination (9) Missing
8. What then is the last grade or level that you completed? (7) Graduate, professional training (6)
Standard college training (4) High school graduation or equivalent (3) Partial high school (2)
9. What kind of work have you done (or did you do) most of your life? (1) Top exec: proprietors
of major business, major professional, (2) Manager, proprietor of medium sized business, lesser
professional (3) Administrative personnel, small business owner, semi-professional, (4) Sales
and clerical worker, technician (5) Skilled workers (6) semi-skilled workers (7) Unskilled
10. (If ever married) What kind of work has your husband or wife done during most of his/her
life? (1) Homemaker (2) Unskilled workers (3) Semi-skilled worker (4) Skilled workers (5) Sales
and clerical worker, technician (6) Administrative personnel, small business owner, semi-
116
professional (7) Manager, proprietor of medium sized business, lesser professional, (8) Top exec:
proprietors of major business, major professional (9) Other (10) Never employed
11. Are you fully employed at present, employed part-time, semi-retired, or fully retired? (4)
12. At the present time, how adequate is your income in meeting your daily needs? (4) It is more
than adequate, (3) It is just enough (2) It is not quite enough (1) It is not at all adequate
13. How much income do you (and your husband /wife—if applicable) have a year?
Yearly Monthly
(1) Under $3,000 $0 - $166
(2) $3,000 - $6,999 $250 - $583
(3) $7,000 – $9,999 $584 - $833
(4) $10,000 – $19,999 $834 – $1,666
(5) $20,000 – $39,999 $1,667 – $3,333
(6) $40,000 or more $3,334 or more
(7) Don’t know
(8) Refused
117
Appendix B
1. Are you formally affiliated with a church, synagogue, or other place of worship?
2. Yes 1. No
Nearly At Least Once A Few Times A Few Times Less Than Never
Every Day A Week A Month A Year Once A Year
6 5 4 3 2 1
4. Besides regular services, how often do you take part in other activities at your place of
worship?
5a. How much have you held positions of offices in your church, synagogue, or other place of
worship?
Appendix C
Now, please tell me whether you “strongly agree,” somewhat agree,” “somewhat disagree,” or
2. One should seek God’s guidance when making every important decision
6. I try hard to carry my religion over into all of my other dealings in life
7. My religious beliefs are what really lie behind my whole approach to life
*8. It doesn’t matter so much what I believe as long as I live a moral life
everyday affairs
10. Although I believe in my religion, I feel there are many more important things in life
Appendix D
Below is a list of problems people sometimes have. Please tell me which answer choice best
describes how much the problem has distressed or bothered you during the past 6 months
including today. The answer choices are “Not at all,” “A little bit,” “Moderately,” “Quite a bit,”
2. Faintness or dizziness
31. Having to avoid certain things, places, or activities because they frighten you
34. The idea that you should be punished for your sins
48. Others not giving you proper credit for your achievements
51. Feeling that people will take advantage of you if you let them
Appendix E
Perceived Health (Index from items commonly used in health-related research; Hooker,
2. Do your health problems interfere with your doing the things you need to?
3. Do you think that you are in better or worse health, or the same, compared to most people your
age?
4. During the past three months, how much has your health worried you?
Appendix F
The following questions ask about people in your environment who provide you with help and
support. Each question has two parts. For the first part, I’ll be asking you to list all the people
you know, up to 9 people and excluding yourself, whom you can count on for help or support in
the manner described. (INTERVIEWER: For each person, list initials and relationship to
1. 4. 7.
2. 5. 8.
3. 6. 9
For the second part of the question, I want you to tell me how satisfied you are with the overall
support you have. Even if you have no support for a particular item, I still want you to tell me
about your level of satisfaction. Part 2 response format: 1 = Very Dissatisfied, 2 = Fairly
Satisfied
1. Whom can you really count on to be dependable when you need help?
2. Whom can you really count on to help you feel more relaxed when you are under pressure or
tense?
3. Who accepts you totally, including both your worst and best points?
4. Whom can you really count on to care about you, regardless of what is happening to you?
5. Whom can you really count on to help you feel better when you are feeling generally down-in-
the-dumps?
6. Whom can you count on to console you when you are very upset?
Appendix G
Appendix H
I agree to participate in the study being conducted by the Center for Lifespan and
Aging Studies at Columbia University. I understand that this involves answering
questions about my attitudes and opinions. I also understand that all of my
responses will be kept strictly confidential, and that I may withdraw from the study
at any time.
Signature ____________________________________
Date ____________________________________
Appendix I
At the present time, how adequate is your income in meeting your daily needs?