Religious Service Attendance and Major Depression
Religious Service Attendance and Major Depression
Our results showed that women with early onset of major depression (before age 18 years) were 1.42 times more likely to stop attending religious services after transitioning to adulthood than women with later onset or no lifetime MDE. This finding, combined with the relatively early onset of depressive disorders, suggests that selection out of religious activities could be a significant contributor to previously observed inverse correlations between religious participation and psychopathology during adulthood. There was little evidence of an increase in religious service attendance subsequent to the onset of depression, although this may have resulted from the fact that over 90% of participants reported attending religious services during childhood, resulting in very small numbers of attendance starters in adulthood. To our knowledge, this is one of the first studies to have shown an impact of selection effects in the association between religiosity and major depression. Prior work with data from a subset of the current sample revealed that current religious service attendance was correlated with lower lifetime odds of MDE. The findings from the current study suggest that at least part of that association is driven by women who stop being religiously active after they become depressed. The impact of religious activity itself, or a change in religious activity, on the course of depression remains unknown.
The topic of reverse causation or selection out of religious activity and its relation to health outcomes has most commonly been discussed in the context of high-risk behaviors. Specifically, there is evidence for selection out of religiosity with regard to outcomes such as delinquency or drug use. Researchers studying these outcomes report that religious adolescents who experiment with drugs are more likely to stop being religiously engaged, even as, overall, original participation in religious activities lowers the risk of drug initiation. At this stage of development, selection as well as reciprocal effects of religious engagement may be playing out simultaneously. Additionally, there is evidence that persons who experience distress related to their religious community (resulting from negative social interactions or conflict with religious teachings, such as conflict that arises when adolescents become sexually active) are more likely to decrease their level of engagement with that community (35, 36) independently of their age. These studies support the hypothesis that specific behavioral and health-related events can precipitate a decrease in a person's level of religious engagement. Furthermore, it is plausible that the perception of negative interactions in religious communities is precipitated in the context of depression and its frequently generated cognitive distortions. The degree to which the depressive symptoms originate independently of the religious community and simply influence the person's perceptions of the community or are a result of negative experiences within the community which serve as "tipping points" in the onset of an MDE cannot be determined. Either pathway could contribute to the selection effect proposed to be present in the literature on religious activity and depression. Although in the current analysis we found evidence of selection associated with early onset of MDE, later MDE onset might similarly lead to changes in religious activity.
Our results suggest that women, but not men, are more likely to stop being religiously active after they become depressed. In other words, men's decrease in religious activity is uncorrelated with depression, even as their overall likelihood of dropping out of religious services is slightly higher than women's (40% of women stop attending services after childhood vs. 46% of men). Prior research has shown that women and Catholics are generally less likely than men and Protestants to stop being religiously active in early adulthood. It is possible that women are likely to stop being religiously engaged only in the context of a significant life change, of which depression onset would be an example. Although the small denomination-specific sample size precluded a full examination, our data do suggest that the link between early depression onset and the stopping-services pattern is somewhat stronger among Catholic women (vs. non-Catholic women).
Furthermore, other factors related to depression risk may also be related to a decrease in religious engagement. For example, an analysis of this same data set found that early-life exposure to residential instability and family disruption were significant determinants of early depression onset —two factors that are also associated with a decrease in religious activity.
The present analysis had several noteworthy limitations. This analysis focused only on major depressive disorder, which was the most prevalent diagnosis in this sample. Therefore, the extent to which the presence of other psychiatric disorders induces similar patterns of religious service attendance could not be inferred. The study population comprised the Rhode Island cohort of the National Collaborative Perinatal Project and thus was not representative of a larger US population. The analysis was also limited by an imprecise reference to childhood for level of religious activity, which may be prone to recall bias. Among participants with data from multiple waves, 12% changed their recollection of childhood service attendance. However, the presence or direction of this change was not correlated with current religiosity levels or any number of demographic factors. Imputation of missing values for childhood attendance (yes/no) also did not yield meaningfully different results. Furthermore, it remains unknown whether use of the phrase "while growing up" elicited memories of young childhood or memories of adolescence. Since the level of religious activity at the time of MDE onset for persons with onset prior to age 18 years remained unknown, it was not possible to determine the original temporal (or causal) association between childhood religious activity and risk of early-onset MDE. This limitation also did not allow for testing hypotheses related to changes in religious service attendance predicting new onset of MDE. Finally, this analysis focused only on religious service attendance, and it is possible that other domains of religiosity might exhibit a different pattern of association with depression or depressive symptoms.
In conclusion, our findings raise a question about whether some of the "action" in the often-reported religion-depression association occurs much earlier in life than previously hypothesized. Future studies stretching from childhood throughout adulthood are needed to adequately address this question, avoiding some of the pitfalls of the typical cross-sectional examination of this relation. Although our findings do not rule out a causal role of religious activity in MDE onset earlier in the life course, the findings do raise substantive questions as to the causative models frequently proposed when assuming that religious involvement is the precursor to health, especially in older adults. Researchers must address, to the extent possible, the possibility of reverse causation when examining the relation between religious engagement and health outcomes.
Discussion
Our results showed that women with early onset of major depression (before age 18 years) were 1.42 times more likely to stop attending religious services after transitioning to adulthood than women with later onset or no lifetime MDE. This finding, combined with the relatively early onset of depressive disorders, suggests that selection out of religious activities could be a significant contributor to previously observed inverse correlations between religious participation and psychopathology during adulthood. There was little evidence of an increase in religious service attendance subsequent to the onset of depression, although this may have resulted from the fact that over 90% of participants reported attending religious services during childhood, resulting in very small numbers of attendance starters in adulthood. To our knowledge, this is one of the first studies to have shown an impact of selection effects in the association between religiosity and major depression. Prior work with data from a subset of the current sample revealed that current religious service attendance was correlated with lower lifetime odds of MDE. The findings from the current study suggest that at least part of that association is driven by women who stop being religiously active after they become depressed. The impact of religious activity itself, or a change in religious activity, on the course of depression remains unknown.
The topic of reverse causation or selection out of religious activity and its relation to health outcomes has most commonly been discussed in the context of high-risk behaviors. Specifically, there is evidence for selection out of religiosity with regard to outcomes such as delinquency or drug use. Researchers studying these outcomes report that religious adolescents who experiment with drugs are more likely to stop being religiously engaged, even as, overall, original participation in religious activities lowers the risk of drug initiation. At this stage of development, selection as well as reciprocal effects of religious engagement may be playing out simultaneously. Additionally, there is evidence that persons who experience distress related to their religious community (resulting from negative social interactions or conflict with religious teachings, such as conflict that arises when adolescents become sexually active) are more likely to decrease their level of engagement with that community (35, 36) independently of their age. These studies support the hypothesis that specific behavioral and health-related events can precipitate a decrease in a person's level of religious engagement. Furthermore, it is plausible that the perception of negative interactions in religious communities is precipitated in the context of depression and its frequently generated cognitive distortions. The degree to which the depressive symptoms originate independently of the religious community and simply influence the person's perceptions of the community or are a result of negative experiences within the community which serve as "tipping points" in the onset of an MDE cannot be determined. Either pathway could contribute to the selection effect proposed to be present in the literature on religious activity and depression. Although in the current analysis we found evidence of selection associated with early onset of MDE, later MDE onset might similarly lead to changes in religious activity.
Our results suggest that women, but not men, are more likely to stop being religiously active after they become depressed. In other words, men's decrease in religious activity is uncorrelated with depression, even as their overall likelihood of dropping out of religious services is slightly higher than women's (40% of women stop attending services after childhood vs. 46% of men). Prior research has shown that women and Catholics are generally less likely than men and Protestants to stop being religiously active in early adulthood. It is possible that women are likely to stop being religiously engaged only in the context of a significant life change, of which depression onset would be an example. Although the small denomination-specific sample size precluded a full examination, our data do suggest that the link between early depression onset and the stopping-services pattern is somewhat stronger among Catholic women (vs. non-Catholic women).
Furthermore, other factors related to depression risk may also be related to a decrease in religious engagement. For example, an analysis of this same data set found that early-life exposure to residential instability and family disruption were significant determinants of early depression onset —two factors that are also associated with a decrease in religious activity.
The present analysis had several noteworthy limitations. This analysis focused only on major depressive disorder, which was the most prevalent diagnosis in this sample. Therefore, the extent to which the presence of other psychiatric disorders induces similar patterns of religious service attendance could not be inferred. The study population comprised the Rhode Island cohort of the National Collaborative Perinatal Project and thus was not representative of a larger US population. The analysis was also limited by an imprecise reference to childhood for level of religious activity, which may be prone to recall bias. Among participants with data from multiple waves, 12% changed their recollection of childhood service attendance. However, the presence or direction of this change was not correlated with current religiosity levels or any number of demographic factors. Imputation of missing values for childhood attendance (yes/no) also did not yield meaningfully different results. Furthermore, it remains unknown whether use of the phrase "while growing up" elicited memories of young childhood or memories of adolescence. Since the level of religious activity at the time of MDE onset for persons with onset prior to age 18 years remained unknown, it was not possible to determine the original temporal (or causal) association between childhood religious activity and risk of early-onset MDE. This limitation also did not allow for testing hypotheses related to changes in religious service attendance predicting new onset of MDE. Finally, this analysis focused only on religious service attendance, and it is possible that other domains of religiosity might exhibit a different pattern of association with depression or depressive symptoms.
In conclusion, our findings raise a question about whether some of the "action" in the often-reported religion-depression association occurs much earlier in life than previously hypothesized. Future studies stretching from childhood throughout adulthood are needed to adequately address this question, avoiding some of the pitfalls of the typical cross-sectional examination of this relation. Although our findings do not rule out a causal role of religious activity in MDE onset earlier in the life course, the findings do raise substantive questions as to the causative models frequently proposed when assuming that religious involvement is the precursor to health, especially in older adults. Researchers must address, to the extent possible, the possibility of reverse causation when examining the relation between religious engagement and health outcomes.
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