Graduation Year

2014

Document Type

Thesis

Degree

M.S.P.H.

Degree Granting Department

Community and Family Health

Major Professor

Bruce L. Levin

Keywords

depression, mediators, mental health, religion, spiritual

Abstract

The population of older adults in the United States is steadily rising. The Centers for Disease Control and Prevention (CDC) recently released a call to reduce mental distress in older adults. Research shows that mental distress is associated with depressive symptoms, which are significantly related to many chronic medical conditions, functional impairment, suicide, and all-cause mortality. Depression is a major public health concern. There is an interest in gerontology research on the buffering role of engagement against depressive symptoms such as volunteering, social activities, and religion. Certain religious beliefs and behaviors contribute to maintaining or improving mental health and research suggests that religiosity may act as a buffer against depressive symptoms. As the population of older adults exponentially increases, there is a need for theory guided research that examines the relationship between religiosity and depressive symptoms and mediators as possible mechanisms.

This study addresses two important gaps in the literature on depressive symptoms within the religious gerontology field: the relationships of a wider range of religious variables with depressive symptoms, and examining health behaviors and social support as mediators. Data were collected from the University of South Florida (USF) Health in The Villages study, a population-based study of older adults residing in an active living community in southwest central Florida. Binary logistic regression analyses were conducted that examined multiple measures of religiosity (organizational religiosity, subjective religiosity, and subjective spirituality) and covariates as predictors of depressive symptoms as defined by the Patient Health Questionaire-2 (PHQ-2). The PHQ-2 is a validated 2-item screener tool for measuring depressive symptoms. A series of mediation analyses were conducted to test for possible mediation of religiosity and depressive symptoms. Proposed mediators included in the mediation analyses were: health behaviors (tobacco use, alcohol use, vegetable/fruit consumption, dietary habits, and medication adherence) and social support (emotional support and availability of a caretaker).

Organizational religiosity was significantly associated with depressive symptoms. However, subjective religiosity and subjective spirituality were not significantly associated with depressive symptoms. Health behaviors and social support did not mediate the relationship of organizational religiosity and depressive symptoms. Findings suggest that increased religious/church service attendance is associated with fewer depressive symptoms. Social support and health behaviors did not mediate the relationship between religious/church service attendance and depressive symptoms. Future research studies should explore other theory-guided constructs as possible mediators of religiosity and depressive symptoms. Additionally, contrasting findings between the relationship of depressive symptoms and subjective measures of religiosity versus organizational religiosity, suggests the continued use of multidimensional measures of religiosity within research. Future research should examine specific aspects of religious service attendance and in relation to depressive symptoms. Furthermore, 41% of participants who attended a religious/church service weekly or more reported depressive symptoms, thus based on their choice to regularly engage in religious activities, they are likely to be receptive to participating in faith-based approaches to address depressive symptoms. Therefore, for communities and individuals who are open to faith-based approaches, findings support the use of spiritually modified depression therapies at the individual level. Also, behavioral health prevention initiatives are recommended at the organizational level such as hosting depression screenings at faith-based health fairs. As the population of older adults continues to rise public health and behavioral health professionals should explore opportunities for collaboration with faith-based communities.

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