Religious Involvement and Depression: The Mediating Effect of Relational Spirituality

Transcription

1 DOI /s z ORIGINAL PAPER Religious Involvement and Depression: The Mediating Effect of Relational Spirituality David R. Paine 1 Steven J. Sandage 1 Springer Science+Business Media New York 2016 Abstract Multiple studies have examined the relationship between religious involvement and depression. Many of these investigations reveal a negative correlation between these constructs. Several others yield either no association or a positive correlation. In this article, we discuss possible explanations for these discrepant findings. We investigate the degree to which relational spirituality factors mediate the relationship between religious involvement and depression in a sample of graduate students. Results indicated that spiritual instability and disappointment in God were distinct predictors of depression over and above the predictive strength of religious involvement. Implications for training and conceptualization are discussed. Keywords Religion Spirituality Depression Training Introduction Scholarly interest in the association between religion and spirituality (R/S) and mental health has grown extensively over the past two decades (see Hill and Pargament 2008; Koenig 2012). Researchers have demonstrated that religious and spiritual factors are correlated with decreased anxiety, decreased depressive symptoms, lower levels of substance abuse, and a greater sense of meaning and purpose in life (Koenig 2012). However, recent empirical findings reveal that individuals also experience religious and spiritual struggles, which are linked with negative mental health outcomes (Exline et al. 2014). Divergent findings on religion and spirituality are evident in studies of religious involvement and depression. Religious involvement may be understood as a construct & David R. Paine drpaine@bu.edu 1 The Albert and Jessie Danielsen Institute at Boston University, 185 Bay State Rd, Boston, MA, USA

2 comprised of (1) the importance individuals place on their religious beliefs (Koenig et al. 2014; Pargament et al. 1988; Schnittker 2001; Worthington et al. 2003) and (2) engagement in communal religious activities (see Ai et al. 2013; Koenig et al. 2014; Krause 2009). While multiple studies indicate religious involvement is negatively associated with depressive symptoms (see Koenig 2012), several studies yield either no association (Koenig et al. 2014) or a positive association (Eliassen et al. 2005; Miller et al. 2008). Contrasting findings suggest that the relationship between religious involvement and depression may not be best explained by a direct linear association, and there is a need for theory-driven studies that can further investigate this relationship. Hill and Pargament (2008) understand religion and spirituality as related constructs. They define spirituality as a search for the sacred and an essential aspect of religious belief and practice (p. 4). The sacred is conceptualized as that which is of Ultimate meaning or significance, including concepts of God and the Absolute. If spirituality is an integral aspect of religion, then the ways in which we engage with the sacred may have implications for the nature of religious involvement and, consequently, mental health. Smith et al. (2003) conducted a meta-analysis of the association between religiosity and depressive symptoms, which included 147 studies. Their results suggest that particular forms of spiritual engagement (i.e., negative religious coping, extrinsically motivated religiosity) play a significant role in determining whether religiosity predicts higher or lower levels of depressive symptoms. There is also empirical evidence indicating that particular expressions of spirituality predict psychological well-being over and above the effects of global measures of religiosity (see Dein 2013). Psychologists often draw on non-religious factors to explain the association between religion and mental health. In recent years, scholars have attempted to explain the relationship between religious involvement and depression in psychological and/or environmental terms. Self-esteem, perfectionism, hope, scrupulosity, social support, and traumatic life events have been posited as decisive factors in the relationship (Allen and Wang 2014; Chang et al. 2013; Holt et al. 2013; Wei and Liu 2013). While this approach is informative and useful, it overlooks the possibility that religious and spiritual variables, in and of themselves, have explanatory power in regard to mental health (Hill and Pargament 2008). The relationship between religious involvement and depression may be more fully understood by examining it within the context of spirituality. Shults and Sandage (2006) define spirituality as ways of relating to the sacred (p. 161). This relational spirituality model asserts that persons relate to the sacred in diverse ways, including love, anger, reverence, indifference, and fear (Sandage and Crabtree 2012). In this study, we explore the relationship between religious involvement, relational spirituality, and depression. To our knowledge, no empirical studies have assessed the link between religious involvement and depression in the context of relational spirituality. We review empirical findings on religious involvement and depression, describe the relational spirituality framework, and review the empirical and theoretical understandings of relational spirituality and depression. Then, we examine whether relational spirituality factors mediate the association between religious involvement and depression. In doing so, we hope to (a) contribute to the understanding of divergent findings on religiosity and depression in the literature and (b) assess the extent to which relational spiritual factors may explain the relationship between religiosity and depression. Finally, we discuss the findings and offer suggestions for future research and training.

3 Religious Involvement and Depression Spilka et al. (2003, p. 509) discuss several ways in which the relationship between religious involvement and depression may be understood. First, religious involvement may be understood as an expression of depression. Over-involvement in religious activities may reflect a diminished sense of personal agency or an attempt to avoid feelings of despair. Second, faith communities may socialize individuals in ways that help them cope with life stressors and/or suppress unwanted thoughts or behaviors related to depression. In this case, religious involvement would be hypothesized to predict lower levels of depression. Third, religious involvement may offer depressed persons a refuge from the cares of daily life, while not necessarily alleviating depressive symptoms. Fourth, religious involvement may be therapeutic in and of itself, helping to alleviate depressive symptoms. Finally, religious involvement may be a deleterious force, contributing to despair. The empirical findings on religious involvement and depression appear to reflect several of these dynamics. The majority of studies in this area indicate a negative association between religious involvement and depression. However, a number of studies yield the either the opposite finding or a more complex profile. In a systematic review, Koenig (2012) identified 178 studies exploring the link between religiosity and depressive symptoms. Of the studies that met his criteria for methodological rigor, the majority (67 %) revealed an inverse relationship between religious involvement and depressive symptoms. Studies also indicated that religious involvement also predicted decreased likelihood of onset, remission, and past diagnosis of depressive symptoms. Ellison and Flannelly (2009) found that African- American adults who report receiving a great deal of guidance from religion in their dayto-day lives were less likely to have been diagnosed with major depression. Van Voorhees et al. (2008) found that engagement in religious activities served as a protective factor against the onset of depression in adolescents. In another study, religiously involved medical inpatients exhibited faster remission of depressive symptoms than less engaged peers (Koenig 2007). While these studies affirm the salubrious nature of religiosity, other findings offer different conclusions. Koenig s (2012) review also featured 13 studies indicating religious involvement predicted higher levels of depression. Eliassen et al. (2005) indicated moderately religious females reported significantly higher levels of depression compared to non-religious and highly religious subjects. Wijngaards-De Meij et al. (2005) found higher instances of depression reported among religious parents who had lost a child compared to their non-religious counterparts. Pargament et al. (2004a) found attempts at (a) spiritual cleansing through religious practice, (b) religious conversion, and (c) confusion/dissatisfaction in congregational relationships were all positively associated with depressive symptoms in a sample of adults. Miller et al. (2008) found that a spiritual direction intervention emphasizing religious involvement was associated with significantly less improvement in depressive symptoms for those actively engaged in substance abuse treatment when compared to a control group. Some researchers set out to explore whether the relationship in question is nonlinear. However, nonlinear explorations of this question yields further discrepancies. Schnittker (2001) observed a U-shaped curvilinear relationship between religiosity and depression such that those exhibiting either high or low levels of religious salience (i.e., subjective importance of religion) reported higher levels of depression than those at moderate religious salience. In contrast, Wei and Liu (2013) observed a curvilinear relationship between

4 intrinsic religiosity and depression in the shape of an inverted U. In their sample, the highest incidence of depressive symptoms was observed in those reporting moderate levels of religiosity as opposed to those reporting either high or low religiosity. The meta-analysis conducted by Smith et al. (2003) reveals more complexity. Across 147 studies, a mild negative association between religiosity and depressive symptoms emerged. However, moderation analyses revealed that religiosity was associated with higher levels of depressive symptoms for individuals exhibiting higher levels of negative religious coping and extrinsically motivated spirituality. Based on these findings, one may conclude that religious involvement is somewhat unreliable in predicting depressive symptoms. Perhaps relational spirituality factors, such as quality of relationship to the sacred, may help to explain these empirical discrepancies. Relational Spirituality Framework As stated earlier, Shults and Sandage (2006) define spirituality as ways of relating to the sacred (p. 161). A relational spirituality framework is based on the theoretical assumption that individuals are in relationship to that which they consider sacred. A common expression of this dynamic in theistic traditions involves individuals in relation to God. However, relational spirituality is not limited to one s connection with a personal, divine being. There are spiritual experiences and practices that may facilitate connection with impersonal entities or processes that are perceived as sacred. Individuals relate to the sacred (as they do to other persons) in many ways. Scholars have articulated and studied several expressions of relational spirituality including attachment to God (Rowatt and Kirkpatrick 2002), spiritual instability, spiritual grandiosity, and disappointment with God, among others (Hall and Edwards 2002). Attachment to God refers to experienced security in connection with God (Jankowski and Sandage 2014). It is a construct based on the attachment dimensions first developed by Bowlby and Ainsworth (see Mikulincer and Shaver 2007). Spiritual instability is an emotionally dysregulated style of relating to the sacred, characterized by emotional reactivity, fear of punishment, and fear of abandonment by the sacred (Sandage and Crabtree 2012). Spiritual grandiosity is a narcissistic way of relating with the sacred. Persons with high levels of spiritual grandiosity perceive themselves more spiritual proficient than others, favored by the sacred, and entitled to spiritual rewards (Moore 2003; Sandage and Moe 2011). Disappointment with God is the degree to which persons have felt angered, let down, or frustrated by God (Exline et al. 2013; Hall and Edwards 2002). Disappointment with God is sometimes combined with realistic acceptance of God, the ability to accept spiritual disappointment while continuing to pursue an intimate relationship with the sacred (Hall and Edwards 2002; Jankowski and Sandage 2014). However, disappointment with God is not always resolved and can sometimes involve chronic spiritual struggles. In recent years, many scholars have exhibited a tendency to view spirituality as exclusively positive. However, spirituality is also characterized by struggles and difficulties, including anger, disappointment, resentment, and anxiety in relation to the sacred (Pargament et al. 2004b). A relational framework views spirituality as potentially contributing to both positive and negative mental health outcomes. In the next section, we review the theoretical and empirical perspectives on the association between relational spirituality and depression.

5 Relational Spirituality and Depression A basic theoretical understanding of the link between relational spirituality and depression affirms that some ways of relating to the sacred are consistent with emotional distress while others are not. However, while problematic styles of relational spirituality may lead to psychological distress, relational ruptures with the sacred may also be opportunities for spiritual and psychological growth. Shults and Sandage (2006) offer a developmental perspective on this dynamic. They assert that maladaptive relations with the sacred can lead to growth and maturity if one persists through periods of psychological distress. Appropriate containment of distress through active engagement of struggles and endurance may bolster self-soothing resources and reveal novel spiritual pathways. While problematic styles of relational spirituality predict depression, they may initiate a journey toward spiritual and psychological maturation in which depression is endured, alleviated, and perhaps transformed. Nevertheless, the mental health risks of spiritual struggles should not be minimized. Empirical research exploring the association between relational spirituality and depression is in its infancy. A recent study demonstrated that adolescents who report having a strong relationship with God manifested lower levels of depressive symptoms than peers who did not report a strong relationship (Goeke-Morey et al. 2014). Desrosiers and Miller (2007) found that higher engagement in the relational dimension of religious and spiritual life was associated with decreases in depression among adolescent girls and boys. Depression was also associated with disruptions in religious coping, reduction in daily spiritual experiences, congregation problems, and other problems of relational spirituality for girls. Hall and Edwards (2002) found realistic acceptance of God, (i.e., maintaining a relationship with the divine despite disappointment) predicted decreased social alienation and a greater sense of meaning and purpose in life. Social alienation and absence of meaning are both potential indicators of depression (American Psychiatric Association 2013). Other studies have shown some expressions of relational spirituality correlate positively with indicators of depression. Sandage and Jankowski (2010) found higher levels of spiritual instability (i.e., an erratic, fear-driven style of relating to the sacred) predicted increases in depressive symptoms in a sample of graduate students. Hall and Edwards (2002) found that both spiritual instability and disappointment in God predicted higher levels of social alienation and lower levels of reported meaning and purpose in life. They also found spiritual grandiosity predicted higher levels of social alienation. There is also evidence to suggest that the association between religious involvement and depression may be explained in part by relational spirituality. Reed and Neville (2014) demonstrated that the association between religiosity and general psychological well-being was mediated by several spiritual factors, including perceived relationship quality with the sacred, in a sample of African-American women. The authors of this study conclude that mental health professionals may draw on their findings to assist clients in cultivating fruitful person-to-divine being relationships (p. 398). The Present Study In the present study, we explore the role of relational spirituality factors in the relationship between religious involvement and depression in a sample of graduate students in the helping professions. In doing so, we assess whether or not the relational spirituality model

6 may be utilized to explain discrepant findings regarding the link between religion and depression. Additionally, depression is prevalent among graduate students (Fogg 2009). Understanding the religious and spiritual dynamics associated with depression may offer broader insight into contributing factors and supports that have implications for personal and professional development. Furthermore, empirical research has demonstrated that mature forms of relational spirituality are associated with adaptive styles of interpersonal relating (Hall and Edwards 2002; Sandage et al. 2011; Sandage and Jankowski 2013). This study may have implications for relational development and well-being among graduate students preparing for vocations in which psychological health and effective, prosocial relational dynamics will be pivotal. First, we hypothesize, based on the majority of studies in the affirmative, that religious involvement will predict lower levels of depressive symptoms. Second, we hypothesize that relational spirituality factors will mediate this positive association. We account for attachment to God, spiritual instability, spiritual grandiosity, disappointment in God, and realistic acceptance of God as potential mediators. Likely candidates for mediation include spiritual instability and disappointment in God, as they have been empirically linked to indicators of depression. Methods Participants Participants were 160 masters-level students from a Protestant-affiliated university in the Midwest USA. Students were recruited through classes and campus announcements. Gift cards to an area bookstore were distributed in exchange for completion of a packet of measures. Participants ranged in age from 21 to 70 and the mean age was (SD = 10.24) years. The sample was 52.5 % female and 47.5 % male. Participants identified as 90.8 % Caucasian, 2.3 % African-American, 1.7 % Multi-Racial, 1.2 % Hispanic/Latino, 1.2 % Asian/Asian American, and 2.9 % Other. Participants identified as being in the following academic programs: 39.8 % Divinity, 15.0 % Marriage and Family Therapy, 13.9 % Children and Family Ministry, 7.5 % Christian Thought, 6.4 % Transformational Leadership, 5.2 % Theological Studies, 2.3 % Global and Contextual Studies, 1.7 % Community Leadership, and 0.6 % Christian Education. Procedure After obtaining institutional review board approval, the researchers sought permission from appropriate staff for opportunities to recruit participants from classes and orientation sessions. A $15 gift certificate to a bookstore was offered as an incentive for participating in the study. Students who took part in the study completed a packet of questionnaires, which included a written explanation of informed consent. Measures Depressive Symptoms The Symptoms Checklist (SC; Bartone et al. 1989) was used to measure symptoms of depression. The checklist contains physical and mental health symptoms asking the

7 participants to report how many times in the past few days they experienced the symptom on a scale of 0 (none) to 3(very often). In this study, we utilized eight items highlighting symptoms consistent with depression such as difficulty concentrating and depressed mood. Validity was demonstrated as higher scores were associated with greater exposure to trauma and less social support in a sample of trauma survivors (Bartone et al. 1989) and negative associations with psychological well-being and DoS (Sandage and Jankowski 2010). In this study, the eight items indicating depression had a Cronbach s alpha of.75. Religious Involvement Religiosity was assessed using the Religious Commitment Inventory-10 (Worthington et al. 2003), which assesses the degree to which subjects are engaged in religious activities and committed to their religious beliefs. The scale was designed to be amenable to multiple religious traditions and has been validated through research on diverse religious samples (i.e., Buddhist, Christian, Hindu, and non-religious). The Religious Commitment Inventory correlates positively with frequency of religious engagement, adherence to values, and forgiveness (Wade et al. 2007; Worthington et al. 2003). Cronbach s alpha in the current study was.79. Relational Spirituality Four measures were utilized to assess distinct manifestations of relational spirituality including attachment to God, spiritual instability, spiritual grandiosity, disappointment in God, and realistic acceptance of God. Attachment to God Rowatt and Kirkpatrick (2002) developed a nine-item self-report measure of the quality of persons relationship to God based on the adult attachment dimensions of anxiety and avoidance. Participants rated the extent to which the items matched their experience in relating to God on a scale from 1 {disagree strongly) to 7{agree strongly). A sample item on the Avoidance subscale included God seems to have little or no interest in my personal problems, on the Anxiety subscale included God s reactions to me seem to be inconsistent. The scale demonstrated construct validity and internal consistency (Rowatt and Kirkpatrick 2002). Rowatt and Kirkpatrick (2002) found Cronbach s alphas of.92 for Avoidance and.80 for the Anxiety subscale. In their study of attachment to God and humility, Jankowski and Sandage (2014) statistically determined that these subscales lacked discriminant validity and that the total scale score was a better measure of insecure attachment to God. Based on these findings we elected to employ the total scale as a measure of insecure attachment to God. Total Cronbach s alpha for this study is.81. Spiritual Instability Spiritual Instability will be measured using a nine-item subscale from the SAI intended to assess difficulty maintaining spiritual equilibrium and fear of divine abandonment. Examples of SI items include I am afraid that God will give up on me and There are times when I feel that God is punishing me. Participants are asked to respond using a fivepoint Likert scale ranging from 1 (not at all true) to 5 (very true). Construct, convergent,

8 discriminant, and incremental validity of the instability subscale has been established (Hall and Edwards 2002; Hall et al. 2007). Hall and Edwards (2002) reported a Cronbach s alpha of.84 for the SI subscale. The reliability coefficient for this study was.62. Spiritual Grandiosity Spiritual grandiosity was measured using a seven-item subscale of the SAI (Hall and Edwards 2002) intended to measure qualities consistent with narcissistic personality traits. Examples of items include I have a unique ability to influence God through my prayers and My relationship with God is an extraordinary one that most people would not understand. Participants are asked to respond using a five-point Likert scale ranging from 1 (not at all true) to 5 (very true). Hall and Edwards (2002; also, see Hall et al. 2007) have demonstrated construct, convergent, discriminant, and incremental validity of the grandiosity subscale. Cronbach s alpha reliability in this study was.77. Disappointment in God Disappointment in God (DG) was assessed using a seven-item subscale of the SAI (Hall and Edwards 2002) designed to assess the degree to which individuals have been frustrated, angered, or let down by God. Items include, There are times when I feel disappointed in God, There are times when I feel betrayed by God, and There are times when I feel angry at God. Hall and Edwards (2002; also, see Hall et al. 2007) have demonstrated construct, convergent, discriminant, and incremental validity of this scale. Hall and Edwards (2002) reported a Cronbach s alpha of.90 for the disappointment subscale. Reliability coefficient for this study was.91. Spiritual Impression Management The five-item spiritual impression management (SIM) (Hall and Edwards 2002) subscale of the SAI was used as a in this study to control for subjects tendency to exaggerate spiritual virtue. Sample items are rated on a five-point scale and include I am always in the mood to pray and I am always as kind at home as I am at church. The SIM scale was developed through factor analyses of the SAI to ensure impression management items loaded on a separate factor and exhibited solid construct validity in relation to other measures of spiritual development (Sandage and Morgan 2013). In this study, the SIM had a Cronbach s alpha of.69. Data Analytic Procedures A hierarchical multiple regression analysis was used to examine the relationship between religious involvement, insecure attachment to God, spiritual instability, disappointment in God, spiritual grandiosity, and depressive symptoms. Religious involvement, insecure attachment to God, spiritual instability, disappointment in God, and spiritual grandiosity all served as independent variables. Depressive symptoms served as the dependent variable. A step-wise model was utilized in order to assess both the respective and cumulative predictive value of the dependent variables in relation to depressive symptoms. Spiritual impression management was controlled for entering it as the first variable in the model. We also investigated whether relational spirituality factors mediated the linear relationship

9 between religious involvement and depressive symptoms, following the procedures outlined by Frazier et al. (2004) for testing mediator effects (Table 1). Results The proposed model predicting depressive symptoms was examined using a hierarchical linear regression analysis. The overall model was significant [F(5,155) = 11.62, p \.001, R 2 =.27, see Table 2]. The percentage of variance accounted for increased significantly with the respective inclusions of religious involvement [(DF(1,159) = 11.28, p =.001, DR 2 =.066] insecure attachment to God [DF(2,158) = 11.64, p =.001, DR 2 =.064], disappointment in God [DF(3,157) = 17.89, p \.001, DR 2 =.089], and spiritual instability [DF(4,156) = 11.00, p =.001, DR 2 =.051] in the step-wise model. Respective direct effects were observed for religious involvement, insecure attachment to God, disappointment in God, and spiritual instability with depressive symptoms. A significant direct effect was observed between religious involvement and depressive symptoms when controlling for spiritual impression management (b =-.257, p =.001). This effect was no longer significant when insecure God attachment was added to the model in Step 2 (b =-.137, p =.097). The significant direct effect for insecure attachment to God (b =.281, p =.001) was no longer significant with disappointment in God was added to the model in Step 3. A significant direct effect for disappointment in God (b =.328, p \.001) was observed in Step 3. The significance of this factor remained when spiritual instability was entered into the model in Step 4. Direct effects for disappointment in God (b =.254, p =.001) and spiritual instability (b =.258, p =.002) were also observed in the complete model. No significant effects were observed for spiritual impression management and spiritual grandiosity. It was found that both disappointment in God and spiritual instability mediated the relationship between religious involvement and depressive symptoms as the direct effect of religious involvement became non-significant when disappointment and spiritual instability were entered into the model (see Frazier et al. 2004). It was also found that both disappointment in God and spiritual instability mediated the relationship between insecure attachment to God and depressive symptoms as the direct effect of religious involvement became non-significant when disappointment and spiritual instability were entered into the model. Discussion In this study, we found that increases in religious involvement predicted lower levels of depressive symptoms in a sample of graduate students in the helping professions. This finding is consistent with the majority of empirical studies on these constructs, indicating a negative association between religiosity and depression. The measure used to assess religious involvement in this study not only assesses religious activity but also subjects overall commitment to their beliefs. Higher levels of commitment suggest an internalized meaning or purpose in connection with religion. Reported meaning predicts decreased severity in depressive symptoms (Blackburn and Owens 2015). Therefore, it is possible that the negative association observed in this study is due in part the commitment dimension of religious involvement that was assessed. If that is true, it would provide

10 Table 1 Descriptive statistics and bivariate correlation matrix of religious involvement, relational spiritual measures, and depressive symptoms M SD SIM RI IAG DG SI SG DS SIM ** -.348** -.221** -.132*.373** RI ** -.181* * -.257** IAG **.339** ** DG ** ** SI ** SG DS N = 160 SIM spiritual impression management, RI religious involvement, IAG insecure attachment to God, DG disappointment in God, SI spiritual instability, SG spiritual grandiosity, DS depressive symptoms * p \.05; ** p \.01 Table 2 Hierarchical regression predicting depressive symptoms (DS) from spiritual impression management, religious involvement, and relational spirituality factors N = 160 SIM spiritual impression management, RI religious involvement, IAG insecure attachment to God, DG disappointment in God, SI spiritual instability, SG spiritual grandiosity, DS depressive symptoms * p \.05; ** p \.01 DR 2 R 2 B SE B B Step SIM Excluded from analysis RI ** Step RI IAG ** Step RI IAG DG ** Step RI IAG DG ** SI ** Step RI IAG DG ** SI ** SG evidence for the notion that religion can be positively or negatively associated with mental health depending on the particular nature of involvement. Future research may explore the components of religious involvement and the degree to which they are differentially associated with various aspects of mental health.

11 In the early stages of the model, insecure attachment to God was found to predict higher levels of depression and mediate the negative association between religious involvement and depression. This would suggest that relational security in the context of religious engagement or professed commitment is a crucial factor in predicting the mental health of believers. Attachment theory asserts that securely attached individuals experience objects of attachment as both a safe haven of protection and a secure base from which to engage with the world. The results suggest that disruptions in the safe haven and or secure base functions of God may be present despite overt religious involvement and can be significantly impairing to mental health. One may have high levels of religious involvement yet feel distant and/or anxious for a better connection with God. Alternatively, persons may not be overly engaged in religion yet feel close to God and, presumably, be less likely to experience depressive symptoms. These findings are consistent with both theory and empirical data linking insecure attachment to higher levels of depression. Attachment research suggests that attachment anxiety is more strongly associated with depression the attachment avoidance. However, other work suggests that each style is associated with distinct manifestations of depression: anxiety being linked with interpersonal expressions of depression (i.e., dependence, low agency) and avoidance being linked with masochistic expressions of depression (i.e., self-criticism, perfectionism) (see Mikulincer and Shaver 2007). Future research may explore the degree to which these patterns are observed in the attachment dynamics between individuals and the sacred. Spiritual instability and disappointment in God each uniquely predicted depressive symptoms over and above the effects of religious involvement and insecure attachment to God. These findings are consistent with previous studies indicating that spiritual instability and disappointment with God are associated with decreased levels of well-being and relational maturity (Hall and Edwards 2002; Sandage and Crabtree 2012; Sandage and Jankowski 2013; Sandage et al. 2010, Strelan et al. 2009). In regard to spiritual instability, the results suggest that excessive preoccupation with abandonment, punishment, and one s status in relation to the divine is conducive to a higher likelihood of depressive symptoms. Spiritually unstable individuals exhibit an emotionally reactive style of relating to the sacred characterized by heightened anxiety in response to undesirable circumstances. Persistent struggles with spiritual anxiety and uncertainty may contribute feelings of helplessness and worthlessness, both of which are diagnostically linked with depression (American Psychiatric Association 2013). Results are also theoretically consistent with findings demonstrating links between spiritual instability indicators of depression (i.e., social alienation and lack of purpose, Hall and Edwards 2002). Spiritually unstable individuals experience tension between their need for spiritual comfort and felt disconnection from God. Preoccupation with the self in relation to the divine may also preclude devotion to a larger purpose or mission. Alternatively, depression may impact relational spirituality such that one becomes inclined to fear and distress in connection with the sacred. Results indicated that disappointment in God also uniquely predicts depression over and above the effects of religious involvement and other relational spirituality factors. Spiritual instability and disappointment with God were positively correlated in this study; nevertheless, the results support the understanding that they are relatively unique spiritual struggles in relation to depression. The positive correlation between spiritual disappointment and depression may be intuitive, as disillusionment with sacred objects would seem to invite spiritual and emotional turmoil (Jones 2002). There is also empirical support for a positive correlation between depression and spiritual struggles with the divine (see Exline et al. 2014). The pessimism associated with depression may serve to increase the salience of negative spiritual experiences, resulting in higher levels of disappointment with God.

12 Future research may explore the developmental trajectory of spiritual disappointment and its impact on mental health. Shults and Sandage (2006) discuss disappointment as a potential contributor to spiritual maturity. They assert healthy relational support is needed to contain the stressful or even traumatic aspects of disappointment in order for its educational, strengthening, and formative potential to be realized. If solid relational containment is needed to transcend spiritual disappointment, it may be fruitful to explore the role of spiritual instability in the relationships between disappointment, mental health, and developmental maturity. The results of this study suggest spiritual instability and spiritual disappointment are distinct spiritual struggles uniquely predictive of depression when controlling for each other. It may be interesting to explore the degree to which disappointment in God predicts developmental outcomes depending at varying levels of spiritual instability. Additionally, it is possible that the relatively high level of religious commitment in this sample may have impacted the experience of spiritual disappointment or spiritual instability. Participants training to be ministers, spiritual leaders, and spiritual counselors may exhibit greater difficultly with anger, fear, and frustration in God than graduate trainees in more secular contexts, since a harmonious relationship with the divine is presumably very important to them. On the other hand, the faith and training context may offer relational, embodied, and emotional resources that may bolster effective coping and psychological endurance. Faith contexts that emphasize duty and practice may invest more pastoral energy in cultivating formative relationships with the divine. The same may be said of individual persons who utilize religious participation as a primary coping mechanism. In the context of training, religious students struggling with depression may benefit from therapy and/or spiritual direction. Training directors seeking to address the relational and spiritual needs of students may offer a supportive interpersonal network among faculty and familiarize themselves with beneficial resources outside the program. The empirical literature reveals discrepant findings on the relationship between religious involvement and depressive symptoms. Our results suggest that relational spirituality factors predict depressive symptoms over and above the effect of religious involvement. Perhaps some of the contradictory findings highlighted in the introduction reflect a failure to account to relational spirituality factors. Religious involvement may predict higher levels of depression when persons relate to God in maladaptive ways (i.e., insecure attachment, spiritual instability). Recurring disappointment in the religious contexts may also contribute to a positive correlation between religious involvement and depression. Particular religious environments may be more or less supportive of adaptive styles of relating to the sacred. Some spiritual communities may cultivate spiritual instability by emphasizing fear, punishment, and uncertainty. Others may over-emphasize the pursuit of moral perfection and set members up for spiritual disappointment. Struggles with congregation members as well as moral struggles have been shown to predict anger and disappointment in God (see Exline et al. 2014). When maladaptive forms of relating to the sacred are explicitly or implicitly encouraged, higher levels of involvement may lead to higher levels of distress. There are a number of limitations to the study. First, the sample is relatively homogeneous in terms of religion and culture. The overwhelming majority of the sample is Euro-American. Future studies exploring the role of relational spirituality in religion and depression with more diverse samples and contexts are needed. Depression, like most all human phenomena, is expressed differently across cultures as values, beliefs, and environmental contributors interact with the individual in distinct ways (Brown 2002). Therefore, religious involvement and relational spirituality factors may have differential

13 impacts on depression depending race, culture, and ethnicity. All participants in this study were also trainees in counseling and ministry in a Protestant Christian setting. In this population, the nature of religious involvement and relational spirituality may carry a different meaning and significance from the general population. Therefore, shifts in religious engagement or changes in relational dynamics may have a divergent impact on our sample. Additionally, this study fails to account for other spiritual factors that may influence the connection between religious involvement and depression. Results indicate that relational spirituality factors only account for about 27 % of the variability in depressive symptoms when controlling spiritual impression management. Any number of internal and environmental factors account for the range of depressive symptoms in any sample. In regard to this area of study, researchers may seek to explore the role of other spiritual variables other than to relational. Future studies may assess the role of spiritual experiences, spiritual practice, spiritual journeying, and spiritually relevant emotions (i.e., elevation) in the relationship between religious involvement and depression. Conclusion The objective of this study was to explore the role of relational spirituality in the relationship between religious involvement and depression. In doing so, we hoped to offer a potential explanation for discrepancies in the empirical literature on the latter constructs. We believe this study achieved both objectives. Results indicated that spiritual instability and disappointment in God predicted depressive symptoms over and above the effects of religious involvement, attachment to God, spiritual grandiosity, spiritual impression management, and realistic acceptance of God. Therapists and ministers working with religious individuals experiencing depression may consider the degree to which they are angry, frustrated, disappointed, or fearful of God. Interventions drawing on spiritual and psychological resources to manage and alleviate these experiences may be worth exploring in treating, guiding, and mentoring said individuals. References Ai, A. L., Huang, B., Bjorck, J., & Appel, H. B. (2013). Religious attendance and major depression among Asian Americans from a national database: The mediation of social support. Psychology of Religion and Spirituality, 5, Allen, G. E. K., & Wang, K. T. (2014). Examining religious commitment, perfectionism, scrupulosity, and well-being among LDS individuals. Psychology of Religion and Spirituality, 6, American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Bartone, P. T., Ursano, R. J., Wright, K. M., & Ingraham, L. H. (1989). The impact of a military air disaster on the health of assistance workers: A prospective study. Journal of Nervous and Mental Disease, 177, Blackburn, L., & Owens, G. P. (2015). The effect of self efficacy and meaning in life on posttraumatic stress disorder and depression severity among veterans. Journal of Clinical Psychology, 71, Brown, G. W. (2002). Social roles, context and evolution in the origins of depression. Journal of Health and Social Behavior, 43, Chang, E. C., Kahle, E. R., Yu, E. A., Lee, J. Y., Kupfermann, Y., & Hirsch, J. K. (2013). Relations of religiosity and spirituality with depressive symptoms in primary care adults: Evidence for hope agency and pathway as mediators. The Journal of Positive Psychology, 8,

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