OVERCOMING EVIL WITH GOOD

Overcoming Evil with Good:

Assessing Correlation Between Religion and Depression
Alice Kang
University of Minnesota
November 23, 2015

OVERCOMING EVIL WITH GOOD

2
Introduction

Can we successfully overcome evil with good? According to World Health Organization
(WHO), it is estimated that depression will be the second leading cause of lost years of healthy
life in 2020. The detrimental effects of depression have caused 350 million people to suffer
worldwide (WHO). Most religions, especially Christianity, promote a hopeful life. It is
appropriate to ponder whether religion can combat or prevent what was or can be lost from
depression. If there is a correlation between religion and depression, people are free to believe
that it is fated by divine intervention or see it from a scientific perspective. If a correlation exists,
researchers can scrutinize their findings further to determine why it exists, thus find preventable
measures. Four different empirical articles related to religion and depression will be summarized.
1. Protective Associations of Importance of Religion []
2. Religious Service Attendance and Spiritual Well-Being []
3. Religiosity and Resilience in Persons at High Risk for Major Depression
4. Neuroanatomical Correlates of Religiosity and Spirituality
From these studies it will be assessed whether it is appropriate to legitimize my hypothesis that
religion has a correlation in combating or preventing depression.

Protective Associations of Importance of Religion []

Purpose and Sample
This research aimed to find if there is a relationship between personal importance of
religion and regularity of attendance at religious services with risk of depression and risk of
behaviors. The researchers received their data from self-report surveys of adolescents from ages
15-19 from 3 different high schools in Cape Breton District Municipality, Canada. 1,615 students
answered self-administered questions concerning their religiosity.

OVERCOMING EVIL WITH GOOD

Measurements
They used logistic regression to evaluate relations of religiosity. This entails personal
importance of religion, which was measured using a four-item scale that was dichotomized as not
at all, not very important, fairly, or very important. Attendance at religious services was also
included, which was measured as never, a few times a year, or, more than once a month. Finally,
these two religiosity variables were then compared to the risk of depression and frequency of
suicidal behaviors. When measuring risk of depression, they used the Center for Epidemiological
Studies Depression Scale. The numbers of suicidal thoughts, plans, or attempts within the year
the study was conducted as behaviors. After preparing their methods, their outcomes showed
empirical results.
Results
They discovered that females and males differed in outcome. In females, low personal
importance of religion, in addition to less frequent service attendance were compared to other
variables like risk of depression and suicidal behaviors. The odds ratio (OR) was used to
determine if an exposure was a risk factor for a particular outcome. According to their data, low
personal importance of religion was associated with depression risk (OR: 1.1-2.1) and suicidal
thinking (OR: 1.3-2.6) at a 95% confidence interval. Because the OR with these two findings is
greater than 1, this means that the exposure (personal importance of religion and less frequent
service attendance) is associated with lower odds of outcome (risk of depression and suicidal
behavior). For males, the data displays no correlation to personal importance of religiosity to risk
of depression and suicidal behaviors. In conclusion, protective association of measures of
religiosity to risk of depression and behaviors are seen in Canadian female adolescents.
Synthesis

OVERCOMING EVIL WITH GOOD

Their results show that a decrease in attendance in religious services and a low scale in
personal importance of religion is related to a higher risk of depression and suicidal thoughts and
behaviors. Due to the fact that only females showed significant findings, I am not able to
generalize these two relations across both genders. However, we still cannot ignore the evidence
of the relationships between religion and depression in females. Therefore I can assess that this
study strengthens my argument in that religion is associated in preventing depression.

Religious Service Attendance and Spiritual Well-Being []

Purpose and Sample
The objective of this study was to explore the relations of religious service attendance
and spiritual well being on the risk of major depression. Spiritual well-being was further
branched out to religious well-being and existential well-being. In the process of strategic
screenings from the Boston and Providence NCPP data, face-to-face interviews, self-report
questionnaires, religiosity modules, the final sample resulted in 918 subjects. In terms of
demographics, 64% were females with an average of 39 years of age.
Measurements
When measuring data, attendance of religious service was asked: Do you go to a church
or temple or other place of worship? and While you were growing up, did you go to a church or
temple or other place of worship? The following choices of the responses were dichotomous of
either any or none. A Spiritual Well-Being scale was created to determine an individuals
spirituality level. This scale was dissected into two interrelated constructs: religious well-being
(10 questions) and existential well-being (10 questions). In the religious well-being section, it
measured the quality in relationship one person has with their religious God. Next, the existential

OVERCOMING EVIL WITH GOOD

well-being disregarded all religious constructs and assessed how one reflects the meaning and
purpose in life. Each individual answered all 20 questions from a scale ranging from agree a lot
to disagree a lot and categorized according to high, medium and low groups. The final
independent variable is the Major Depressive Episode (MDE), which was sought out through
interviews determining the presence of lifetime MDE using the composite International
Diagnostic Interview (CIDI) and DSM-IV criteria. People who had an MDE within a year were
enlisted as currently depressed.
Results
They discovered that individuals who have been to a religious service had almost 30%
lower odds of MDE than those who never attended service. According to their data, people who
were categorized by high levels of existential well-being had more than 70% reduced odds of
MDE. When comparing all the measured variables, they found that existential well-being had the
strongest correlation with reduced odds of MDE. In contrast to my hypothesis, their study
showed that higher levels of religious well-being were correlated with 1.5 times higher odds of
depression. In conclusively, this study is a paradigm of how different aspects of religiosity and
spirituality are differentially correlated with depression.
Synthesis
It was found that people who have been to any kind of religious service in their
lifetime exhibited 30% lower odds of experiencing an MDE. With this result I can conclude that
religion is correlated to MDE. It is also stated that people who considered themselves as having a
high quality relationship with their God exhibited higher chances of depression. I believe that
this study shows lack of evidence to support my argument for the following reasons. One, I am
not convinced that one religious service in an individuals lifetime can show such significant

OVERCOMING EVIL WITH GOOD

correlation in combating depression. Two, this data simply shows that people with higher
religious well-being are related to having a 1.5 higher risk of depression. Furthermore, the
existential well-being could potentially influence someones sense of life purpose, so it could be
probable that individuals who report positive attitudes could indicate more resilience against
depression. Lastly, this approach was too generic and simple. For an example, it focused
primarily on a single domain such as religious service attendance and this may be falsely
misinterpreted as the true definition of relationship between religiosity, spirituality and
depression. Due to such limitations, this study contains insufficient evidence when supporting
my claim.

Religiosity and Resilience in Persons at High Risk for Major Depression

Purpose and Sample
In this study, their main objective was to see if religiosity could constitute for a protective
factor in high-risk individuals for MDD. People were picked according to their biological risk
factors. Participants were picked according to whether they were offsprings of depressed
parents, from in outpatient clinic data pool at Yale University. The controlled factor was
offsprings of non-depressed parents who were confirmed controlled representatives by
successfully passing the evaluation for psychiatric disorders and were found in a survey from the
same community. The experimental and controlled variables were required for a 10-year and 20year follow-up. 59% were females and the mean age was 29 years.
Measurements
Most measurements were assessed at the 10-year follow-up, where participants were
asked: How often, if at all, do you attend church, synagogue, or other religious or spiritual

OVERCOMING EVIL WITH GOOD

services? The options for the response was 0=never, 1=less than once a year, 2=once or twice a
year, 3=about once a month, 4=once a week. Personal beliefs regarding religious/spiritual
importance were assessed with the question: How important to you is religion or spirituality?
The response options were ranked from 1-4, 4 being highly important. Religion variables are
referred to in this study as denomination, attendance and importance. The participants were then
categorized according to exposure to negative life events (NLEs). There were 3 different levels
of NLEs such as high, average, or low.
Results
Their results indicated that high attendance rate was related to significantly less odds for
mood disorder by 43% in both groups. However, they found that odds were considerably lower
in the group with non-depressed parents than in depressed parents. Offspring of depressed
parents were further analyzed in combination to NLE. Within this group they found that more
attendance in religious services was associated with significantly reduced odds for MDD by
76%. Offspring of depressed parents with high NLE who defined their relationships with God to
be highly important was associated with significantly reduced odds for mood disorder by 74%.
Thus, more religiosity affiliation may contribute to resilience in certain high-risk individuals.
Synthesis
This data showed the largest significance between religiosity and resilience in depression.
This research is very similar compared to the two previous ones, in that they all measured
attendance and strategically calculated if it linked to depression in preventable or combative
ways. In this research, the most noteworthy finding was that a high attendance rate in religious
services reduced odds of MDD by 76%. In comparison to the study from the article, Religious
Service Attendance and Spiritual Well-Being [], they only offered two options of any or

OVERCOMING EVIL WITH GOOD

none when measuring attendance. However, this research study included a 0-4 scale. When
using a larger scale people can visualize a linear change, in that the more frequent attendance
shows a linear decrease for the risk of depression in high risked individuals. I found that this
article was most substantial in supporting my hypothesis; religiosity does have a correlation to
combating or preventing depression.

Neuroanatomical Correlates of Religiosity and Spirituality

Purpose and Sample
The objective of this study is to determine if high-risk adults who conveyed high
importance of religion or spirituality had thicker cortices in the brain. This was a longitudinal
study consisting of 103 participants who were the second- or third-generation offspring of
depressed (high familial risk) or nondepressed (low familiar risk) probands (first generation).
Religious or spiritual importance and church attendance follow up were done two times within
five years. The demographics for these participants are from the ages 1854 years of age and
61% of them being female.
Measurements
The questions on religiosity were determined by asking the importance of religion on a
personal level on a scale of 1-4 (4 being highly important). In regards to the frequency of
religious services, participants had 4 options to choose from (never to once a week or more). The
responses to the importance and the frequency of attendance were independently dichotomized
as either high (3) or low importance and either high or low attendance. As for measuring
cortical thickness, researchers measured in template space using a 3D morphologic operator, then
a statistical evaluation of cortical thickness was measured. This permitted them to compare

OVERCOMING EVIL WITH GOOD

cortical thicknesses between groups and to correlate thickness with measures of religious
importance and ratings of anxiety or depression. We correlated cortical thickness with the
importance and the frequency of church attendance while controlling for age, sex, and familial
risk for MDD.
Results
They found that the marked effect on personal religious importance on cortical thickness
exhibited significantly stronger correlation in the high-risk group than the low-risk group. Those
who stated that religion was important had a thicker cortex by 1mm. Therefore; a cortex that is
thicker in measurement associated with a high importance of religion or spirituality may suggest
resilience of depression in individuals at high risk for major depression.
Synthesis
I found that this article offers the most reliable evidence when confirming the association
of depression and religiosity because using biological evidence to support the associations
between the two variables by measuring the cortical thickness is more accurate than a low to
high ranked scale used in the other researches. It was noted that there was a 1mm thicker cortex
along the mesial wall of the left hemisphere. This is within the same region that is associated
with developing depressive illness. It was reported that thinner walls was linked to higher
chances of obtaining a depressive illness. When integrating these findings from this study, I am
confident to say that there is a correlation of religiosity and resilience to depression.

OVERCOMING EVIL WITH GOOD

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Conclusion

Possible limitations should also be considered. Most of these studies used a simple
dichotomous to measure attendance and personal importance, which disregards other possible
variations that could have made an impact. Instead of generalizing attendance as low and high, I
suggest specific options like taking the average number of times a participant attends a service in
a month for 6 months. Some studies were very age and location specific such as in the
Protective Associations of Importance of Religion [] study; their sample consisted of
students from ages 15-19 in a rural area in Canada. This is too narrow of a sample to represent a
whole population. Another limitation is that all these studies used two measures to capture
religiosity, attendance and personal importance. Religiosity should be defined more specifically
and researchers in the future should consider measuring religious affiliated events such as small
groups, retreats, revivals, and conferences. For future research, it would be interesting to see if
there is a relationship between devoted religious people and protection against depression or the
odds of relapse. I believe it would show a significant difference in results because devoted
religious people could lead to a different lifestyle than those who only attend service.
It is evident from these empirical articles that the correlation of attending religious
services and personal religious importance pertains to resilience in depression. However, it
should be noted that these articles are not stating that religiosity is a casual affect to resilience,
but they offer enough evidence that supports the associations between the two. Whether these
findings suggest that practicing religion can lead to a specific way of lifestyle and mentality
requires additional research. It is difficult to uncover a black and white answer due to the many
significant limitations from these studies. However, if I were to base my hypothesis on these four
studies alone, I would conclude that religion suggests resilience to depression.

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Reference

Demographics

Measure

Results

Rasic, Daniel, Steve

Kisely, and Donald B.
Langille

N = 1,615
Female: 49%
Ages:15-19

Self-administered paper questionnaires.

Risk for depression (CES-D):
Adolescent females: 24
Adolescent males: 22
Religiosity: attendance- never/a few
times a year vs. attendance
once/month. Importance- Not at all/not
very important vs. fairly/very important.

Low personal importance of

religion was associated with
depression risk and suicidal
thinking,

Religiosity: Attendance-0 (never), 1(>1

yr), 2(1-2/yr), 3(1/mo.), 4(1/wk);
Personal Importance-1 (not important), 2
(slightly), 3 (moderate), 4 (highly).
Cortical thickness: anatomical images
with magnetic resonance imaging

Importance of religion or
spirituality, but not frequency
of attendance, was associated
with thicker cortices in the left
and right parietal and occipital
regions.

Diagnostic interviews DSM-III

diagnoses at baseline and DSM-III-R
diagnoses at the 10-yr follow-up. At 20yr follow-up, the SADS-L interview
modified to meet DSM-IV.
Religiosity: Attendance-0 (never), 1(>1
yr), 2(1-2/yr), 3(1/mo.), 4(1/wk);
Personal Importance-1 (not important), 2
(slightly), 3 (moderate), 4 (highly).
NLE: high, average, low
Depressed parents: out-patient clinic at
Yale University
Non-depressed parents: drawn from a
1975 survey from same community and
had no history of psychiatric illness
based on four lifetime diagnostic
interviews.

Increased attendance was

associated with significantly
reduced odds for MDD by
43% in all off springs

Structured diagnostic interviews.

Depression according to DSM-IV
Religiosity: attendance- any or none;
spirituality- low, medium, or high.
MDE: CIDI and DSM-IV. Those with an
episode that started in the previous year
were considered currently depressed

Religious service attendance

was associated with 30%
lower odds of depression.

2011

Lisa Miller, Ravi

Bansal, Priya
Wickramaratne, Xuejun
Hao, Craig E. Tenke,
Myrna M. Weissman,
Bradley S. Peterson.
2013

Kasen, S.,
Wickramaratne, P.,
Gameroff, M. J., &
Weissman, M.

N=103
Female: 63%
Ages: 18-54.
Second- or third-generation
offspring of depressed
(high familial risk) or
nondepressed (low familiar
risk) probands (first
generation).
N=126 depressed parents
N= 59 nondepressed
parents
Females: 59%
Mean age: 29 yrs

2012

Maselko, J., Gilman, S.

E., & Buka, S.

N = n=918
Females: 65%
mean age=39 years

2009
Data from NEFS. Rhode
Island and Boston,
Massachusetts. 35-44 yrs.

Attendance was associated

with both substance use
behaviors and with suicidal
thinking.

Increased importance was

associated with significantly
reduced odds for mood
disorder (by 74%) only in
offspring of depressed parents
with high NLE exposure.
Greater religiosity may
contribute to development of
resilience in certain high-risk
individuals.

Religious and existential wellbeing may be differentially

associated with likelihood of
depression.

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12
Reference

Kasen, S., Wickramaratne, P., Gameroff, M. J., & Weissman, M. M. (2012). Religiosity
and resilience in persons at high risk for major depression.Psychological Medicine, 42(3), 509
519. http://doi.org/10.1017/S0033291711001516
Lisa Miller, Ravi Bansal, Priya Wickramaratne, Xuejun Hao, Craig E. Tenke, Myrna M.
Weissman, Bradley S. Peterson. Neuroanatomical Correlates of Religiosity and
Spirituality. JAMA Psychiatry, 2013; 1 DOI: 10.1001/jamapsychiatry.2013.3067
Maselko, J., Gilman, S. E., & Buka, S. (2009). Religious service attendance and spiritual
well-being are differentially associated with risk of major depression.Psychological
Medicine, 39(6), 10091017. http://doi.org/10.1017/S0033291708004418
Rasic, Daniel, Steve Kisely, and Donald B. Langille. "Protective Associations of
Importance of Religion and Frequency of Service Attendance with Depression Risk, Suicidal
Behaviours and Substance Use in Adolescents in Nova Scotia, Canada."Journal of Affective
Disorders 132.3 (2011): 389-95. Science Direct. Web. 22 Nov. 2015.
http://www.sciencedirect.com.ezp1.lib.umn.edu/science/article/pii/S0165032711000905
Tarver, T. (n.d.). Living Well With Chronic Illness: A Call for Public Health Action.
Journal of Consumer Health On the Internet, 112-113. Retrieved November 20, 2015, from
http://www.who.int/mental_health/advocacy/en/Call_for_Action_MoH_Intro.pdf