Psychology of Religion and Spirituality

Adverse Childhood Experiences and

Religiosity/Spirituality in Emerging Adolescents in India
Anthony F. Santoro, Sonia Suchday, Amina Benkhoukha, Natasha Ramanayake, and Suman
Kapur
Online First Publication, June 29, 2015. http://dx.doi.org/10.1037/rel0000038

CITATION
Santoro, A. F., Suchday, S., Benkhoukha, A., Ramanayake, N., & Kapur, S. (2015, June 29).
Adverse Childhood Experiences and Religiosity/Spirituality in Emerging Adolescents in India.
Psychology of Religion and Spirituality. Advance online publication.
http://dx.doi.org/10.1037/rel0000038

Psychology of Religion and Spirituality

2015, Vol. 7, No. 3, 000

2015 American Psychological Association

1941-1022/15/$12.00 http://dx.doi.org/10.1037/rel0000038

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Adverse Childhood Experiences and Religiosity/Spirituality in Emerging

Adolescents in India
Anthony F. Santoro

Sonia Suchday

Yeshiva University

Pace University

Amina Benkhoukha and Natasha Ramanayake

Suman Kapur

Yeshiva University

Birla Institute of Technology & Sciences

The present exploratory study examined childhood adversity and religiosity and spirituality (R/S) in a
sample of adolescents from Hyderabad, India. Self-reports of childhood adversity and R/S were obtained
from 139 adolescents (M 13.80 years, SD 1.00). Results suggest adversity and existential well-being
were significantly and inversely related. Additionally, adversity significantly predicted a desire to
connect with a Higher Power. Boys endorsed a greater number of adverse childhood experiences, except
physical abuse, which was endorsed at comparable rates by gender. Girls reported greater degrees of
well-being and religiosity; however, no gender differences were found on daily spiritual experiences and
religious coping. Well-being was significantly associated with religiosity, daily spiritual experiences, and
religious coping for girls. Adversity was associated with greater desire to connect with a Higher Power
in boys and increased religious coping in girls. The present study was a preliminary effort to examine
childhood adversity and R/S in populations that are underrepresented in the literature.
Keywords: adolescent spirituality, adverse childhood experiences, Eastern adolescents, emerging adolescents,
Indian adolescents

Research suggests that adversity and R/S have a reciprocal

relationship. Religious and spiritual beliefs may buffer the impact
of adversity, and adversity experienced during adolescence influences religious beliefs as adults (Dervic, Grunebaum, Burke,
Mann, & Oquendo, 2006). Enduring childhood abuse often results
in loss of religious and spiritual values (Dervic et al., 2006), as
well as insecure attachment to a Higher Power (Reinert & Edwards, 2009). Hence, adversity during the formative years not only
has lingering effects in adulthood, it also appears to interfere with
the development of R/S beliefs that may buffer against the effects
of adversity. These findings suggest that further study is warranted
in exploring spiritual and religious engagement, such as coping,
prayer, and personal devotion, as potential protective factors that
buffer against psychological distress among individuals with a
history of abuse (Dervic et al., 2006).

Childhood adversity refers to experiencing abuse (e.g., sexual,

physical, psychological), neglect (e.g., physical, environmental,
emotional), or significant household dysfunction (e.g., living with
a household member who is diagnosed with a mental illness,
abusing substances, or incarcerated) during the developmental
years, specifically before 18 years old. Adversity experienced
during childhood impacts on health and functioning throughout the
life span (Dube et al., 2009; Edwards, Holden, Felitti, & Anda,
2003; Morgan, 2009). Religious and spiritual beliefs and related
practices may enable better coping with adversity during the
developmental years and potentially mitigate the impact of adversity on health. Data indicate that religiosity and spirituality (R/S)
aid in the recovery from trauma (Morgan, 2009).

Childhood Adversity, Religiosity/Spirituality,

and Adolescents

Anthony F. Santoro, Department of Clinical Psychology (Health Emphasis), Ferkauf Graduate School of Psychology, Yeshiva University;
Sonia Suchday, Department of Psychology, Pace University; Amina Benkhoukha and Natasha Ramanayake, Department of Clinical Psychology
(Health Emphasis), Ferkauf Graduate School of Psychology, Yeshiva
University; Suman Kapur, Department of Biological Sciences, Birla Institute of Technology & Sciences.
Natasha Ramanayake is now at Center for Multicultural Mental Health
Research, Cambridge Health Alliance/Harvard Medical School.
Correspondence concerning this article should be addressed to Anthony
F. Santoro, Department of Clinical Psychology (Health Emphasis), Ferkauf
Graduate School of Psychology, Yeshiva University, Bronx, NY 10461.
E-mail: anthony.santoro@psych.ferkauf.yu.edu

The potential health risks related to experiencing childhood

trauma and adversity may be attenuated by strong religious beliefs
and personal spirituality in adolescence. Many studies have linked
R/S to positive health outcomes and overall well-being in adults
(Brown, Carney, Parrish, & Klem, 2013; Chattopadhyay, 2007;
McCullough, Hoyt, Larson, Koenig, & Thoresen, 2000; Oman &
Thoresen, 2005), as well as in adolescents (i.e., ages 10 19) (Burg,
Mayers, & Miller, 2011; Oman & Thoresen, 2006). The link
between childhood adversity and R/S appears to be consistent
across the life span. During adolescence, relational spirituality,
ones personal relationship with a higher power, has been shown to
1

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

SANTORO ET AL.

be a protective factors against depression for adolescent girls

(Desrosiers & Miller, 2007). In adulthood, frequency of religious
service attendance and subjective religiosity have been shown to
be positively related to well-being and attenuate the influence of
work stress on negative affect (Lechner, Tomasik, Silbereisen, &
Wasilewski, 2013). In addition to mental health benefits, research
has also suggested physical health benefits associated with religious and spiritual engagement; studies have found a positive
relationship between involvement in religious practices and better
health outcomes (Larimore, Parker, & Crowther, 2002; Chatters,
2000). Pathways by which religiosity and spirituality influence
health include encouraging healthy behaviors, increasing social
support and resources, and promoting positive psychological states
compared with those not engaged in religious and spiritual practices (Oman & Thoresen, 2002).
Given the possibility of R/S buffering against the effects of
trauma, exploration of the ways in which adolescents religious
beliefs and spiritual understanding may promote positive health
outcomes may be helpful in identifying avenues of promoting
health and well-being (Cotton, McGrady, & Rosenthal, 2010).
During adolescence, youth are faced with integrating what they
have learned and what they have experienced, which can result in
a deeper, more personal relationship with the sacred or an aversion
to religious and spiritual dimensions (Burg et al., 2011). Religiosity affords connection to a community, and spirituality affords
connection to a Higher Power. This sense of connection may
empower youth by offering a source of stability and security (Burg
et al., 2011; Oman & Thoresen, 2006; Rao et al., 2013; Rosmarin
et al., 2011). These benefits of R/S may be especially relevant for
youth currently enduring adversity, whose environment may lack
this sense of connection, stability, and security, as well as those
who have experienced past trauma (Morgan, 2009).

Religiosity/Spirituality and YouthGroup Differences

In Western samples, significant group differences have been
found between gender groups and among different religious affiliation (Bruce, Cooper, Kordinak, & Harman, 2011). Studies of
Western samples suggest females maintain their adolescent faith
and R/S practices to a greater degree than their male peers (Allen
& Brooks, 2012). Moreover, R/S beliefs and rituals from childhood may be more essential to the identity of college-aged females
as compared with college-aged males (Allen & Brooks, 2012). As
gender differences exist in the degrees of R/S domains, gender
differences have also been identified with regard to the protective
effects of R/S. Eliason, Burke, van Olphen, and Howell (2011)
found that R/S factors were protective against alcohol use in
female, but not male, college students. A separate study of collegeaged young adults found significant gender differences in the
influence of R/S on sexual behaviors, with R/S influencing sexual
behavior for male but not female college students (Luquis, Brelsford, & Rojas-Guyler, 2012). Research consistently suggests that
both the degree of R/S and the effects of R/S may differ by gender.
In addition to gender differences in R/S domains, differences
have been noted among cultural and religious groups. For example, Patel, Ramgoon, and Paruk (2009) found that Black and Indian
college students endorsed higher levels of religiosity than White
peers. Results also found differences within cultural groups, with
Muslim and Christian Indian students endorsing higher level of

satisfaction than Hindu Indians, and Christian Indians endorsing a

greater level of spiritual well-being compared to Hindu Indians
(Patel and colleagues, 2009). It appears that differences exist
among religious groups and that a culture-religion interaction may
influence the experience, use, and development of R/S domains.
Of note, most of the information available on nonJudeoChristian, non-Western group differences have come from data
collect from Western participants who report Eastern ancestry.
Individuals of Eastern ancestry who live and developed in Western
societies may differ considerably from individuals who live and
developed in Eastern societies. For example, the experience of a
Hindu Indian adolescent raised in the United States can be understood as substantially different from a Hindu adolescent raised in
India, where Hinduism is the primary religion.
Recent efforts have been made toward developing a universal
model of the spiritual developmental process (Piedmont & Leach,
2002) and in exploring R/S domains in youth from cultures and
religious belief systems that are underrepresented in the literature
(Benson, Roehlkepartain, & Rude, 2003; Tarakeshwar, 2013).
Likewise, there is a need to validate findings found primarily in
Christian samples in populations from non-Christian religions and
spiritual belief systems (Tarakeshwar, Pargament, & Mahoney,
2003; Tarakeshwar, 2013). Cross-cultural studies addressing the
potentially protective aspects of religiosity and spirituality for
youth are warranted (Burg et al., 2011). Study of R/S in nonWestern populations has lagged behind the study of R/S in Western samples, and research on samples from developing countries
are scarce or nonexistent (Kattimani, Sarkar, Bharadwaj, & Rajkumar, 2014). Likewise, the studies available commonly oversample Christian participants, distorting the representativeness of
the culture being studied. As the field develops, it is necessary that
an effort be made to promote international research that studies
Eastern samples. Although R/S practices and views of the sacred
may vary cross-culturally and over time (Leach, Piedmont, &
Monteiro, 2001), human beings drive to connect with something
greater than oneself has been a constant throughout history (Piedmont & Leach, 2002), and international research will aid the
development of cross-cultural, universal aspects of theories of R/S
development.

Indian Youth and Religiosity/Spirituality

The current study focuses on exploring childhood adversity and
R/S in Indian adolescents. Of note, these constructs have yet to be
empirically examined in non-Adult, Indian samples. India is a
highly religious country, with religion acknowledged among the
people as a mechanism of coping. Religiosity and spirituality are
central aspects of the daily lives of Indians and deeply embedded
in every aspect of functioning including health and well-being
(Verma & Saraswathi, 2002). In addition to reporting greater
engagement in religious practices, compared with college students
in the U.S., data exist that show Indian college students are more
likely to engage in spiritual reflection and meditation as a means of
coping with mental illness (Nieuwsma, Pepper, Maack, & Birgenheir, 2011). In an international survey study of values in 2006,
93.1% of Asian Indians reported believing in God (World Values
Survey Association, 2009). Likewise, a poll of 757 Asian Indian
college students found 77% of the sample preferred to identify
themselves as spiritual rather than religious, with 16% considering

ACE AND R/S IN INDIAN ADOLESCENTS

themselves very spiritual, 49% as moderately spiritual, 28% as

slightly spiritual, and only 7% as not spiritual at all (Speaking Tree
Bureau, 2011). Additionally, 91% of the sample reported visiting
places of worship when experiencing stress (e.g., during exams),
two thirds reported praying at least once a week, and only three
percent denied praying at all (Speaking Tree, 2011). These data
suggest that religious and spiritual factors may be potent influences on Indian youths development, health, and sense of wellbeing.

Hypothesis 2: Gender difference will exist, with girls scoring

higher on R/S measures.
Hypothesis 3: Higher rates of adversity will predict (a) a
greater desire to connect with a Higher Power and (b) increased positive religious coping.

Method
Participants

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Religiosity/Spirituality and Indian YouthGroup

Differences
Only in the last few years has research begun to explore gender
differences in R/S domains outside American and European samples; recently, data exploring R/S constructs across developmental
stages for Eastern adolescents from Collectivist cultures have
emerged (Brown, Chen, Gehlert, & Piedmont, 2013). These data
from a sample of Asian Indian college students support the application and study of validated R/S instrument in studying Eastern
samples (Brown et al., 2013). In addition to confirming the factor
structure of their R/S measure in an Eastern sample, these
researchers found women scored higher than men on all R/S
subscales, except a subscale measuring religious crisis, which
denoted high scores for men (Brown et al., 2013). Additionally,
age group differences were noted, with R/S increasing during late
adolescents and into adulthood (Brown et al., 2013). This important study provides evidence that there is a common experience of
R/S that transcends culture and that, similar to Western samples,
Eastern samples may also demonstrate significantly different experience by age and gender (Brown et al., 2013). In a separate
study of 453 young adults, aged 18 to 24, from Kerala, India,
significant differences were found among religious groups, with
Hindus believing religiosity includes following prescribed rituals
and religious leaders to a lesser degree than their Muslim and
Christian peers, even after controlling for potentially confounding,
sociocultural variables (Ganga & Kutty, 2013). Kattimani and
colleagues (2014) found R/S was inversely associated with anger
and anger expression in a sample of medical students from southern India (Kattimani et al., 2014), providing evidence that R/S may
serve as a protective factor in Eastern samples. Of note, research
exploring R/S domains in Indian adolescents younger than 18
years old is nonexistent.

Current Study and Hypotheses

The present study explored the relationship between adverse
childhood experiences (i.e., abuse, neglect, and household dysfunction), R/S domains, and well-being in a sample of emerging
adolescents, ages 12 to 18, from Hyderabad, India. Adolescence is
a critical period of development (Good & Willoughby, 2008; King
& Boyatzis, 2004); however, data on Indian adolescents within this
age range are nonexistent. The primary goal of this exploratory
study was to provide support for future research within this underrepresented population.
The following were hypothesized:
Hypothesis 1: Greater adversity during childhood will predict
lower levels of well-being.

Participants comprised a sample of 139 adolescents, 76 males

(55.1%) and 62 females (44.9%), whose age ranged from 12 to 18
years (M 13.80, SD 1.00), with the majority of the sample
being 13 (40%) and 14 (33.3%) years old, with 15- (16.5%), 16(4.3%), 17- (0%), and 18-year-old (0.7%) participants accounting
for the remaining percentage. Within the current sample, 106
(76.3%) of the adolescents specified a religious affiliation, and of
those who responded, 76.4% identified as Hindu, 16% as Muslim,
2.9% as Christian, 0.7% as Sikh, and 2.8 as Other.

Procedure
Questionnaires were administered to adolescents currently enrolled at a secondary school in Hyderabad, India following informed consent from a guardian and student assent. Participation
was voluntary, and students were not given incentives for their
participation. Data were collected during school hours over a 2-day
period during the winter of 2013. Each student completed the
questionnaire in one sitting. Institutional Review Board (IRB)
approval from the Albert Einstein College of Medicine and appropriate authorities in India was secured before all data collection.

Measures
Adverse Childhood Experiences Scale. The Adverse Childhood Experiences Scale (ACE; Felitti et al., 1998) was used to
assess childhood trauma and stress. The scale comprises of 10
dichotomous items covering abuse (i.e., psychological, physical,
sexual, psychological neglect, physical neglect) and household
dysfunction (i.e., parental separation/divorce, domestic violence,
drug use/dependence, mental illness, incarceration). A composite
score was computed by summing the 10 items. To accommodate
outliers at the high end of the distribution, total scores were
collapsed, which is a common method of preparing ACE data for
analysis (Anda et al., 2008; Dube et al., 2002; Hillis et al., 2004;
Ramiro, Madrid, & Brown, 2010). Total scores ranged from zero
to six, with six being assigned to participants reporting six or more
ACE categories. Missing values were not imputed for this measure. In the present study, the Cronbachs alpha coefficient was
.78. Descriptive statistics for ACE items are presented in Table 1.
Spiritual Well-Being Scale. The Spiritual Well-Being Scale
(SWBS; Paloutzian & Ellison, 1982) is the most frequently used
measure of R/S throughout the literature (Burg et al., 2011) and
measures nondenominational spirituality (Scott, Agresti, & Fitchett, 1998). The SWBS comprises two subscales: the Religious
Well-Being Scale (RWBS), which measures relationship with a
higher power, and the Existential Well-Being Scale (EWBS),
which measures sense of direction, purpose, and meaning in life

SANTORO ET AL.

4
Table 1
Descriptive StatisticsAdverse Childhood Experiences by
Gender and Quantity

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

ACE category

Girls %

Boys %

Total % (n)

14.3
18.2
1.9
9.1
3.7

21.4
18.3
6.9
28.2
20

18.1 (127)
18.1(127)
4.8 (125)
20.5 (127)
12.8 (125)

3.6
5.4

10
22.4

7.1 (126)
14.5 (124)

1.8
5.3
1.8

4.6
7.5
8.8

3.3 (122)
6.4 (125)
5.4 (126)

Childhood abuse
Psychological/emotional
Physical
Sexual
Psychological neglect
Physical neglect
Household dysfunction
Parents separated/divorced
Domestic violencemother
Alcohol/drug problemshousehold
member
Mental illness
Incarceratedhousehold member
Number of ACE categories
(ACE total score)

Girls %

Boys %

Total %

0
1
2
3
4
5
6

66.7
19.3
7.0
3.5
0
1.8
1.8

47.2
19.4
9.7
8.3
6.9
4.2
4.2

55.4
20.0
8.5
6.2
3.8
3.1
3.1

Note. Percentages of girls, boys, and total sample endorsing each adverse
childhood experiences category of the adverse childhood experiences scale
(ACE; Felitti et al., 1998) and percentages of the number of domains
endorsed by participants. n number of participants who responded to
each adversity domain. The variation in sample size is attributable to
missing data.

(Ellison, 1983). Each subscale consists of 10 statements. Participants are asked to respond to the degree to which they agree or
disagree with each statement. Responses are measured on a 6-point
Likert-type scale, ranging from strongly disagree to strongly
agree. After recoding reverse-coded items, subscale scores were
computed. If the participant answered at least six items within a
subscale, the subscale average was calculated for that individual
participant and imputed for missing values within the subscale.
The Cronbachs alpha coefficient for the RWB and the EWB
subscales were .82 and .81, respectively. These coefficients are
comparable with those reported in the literature for nontraditionally religious (i.e., non-Judeo-Christian) college students, with .93
for RWB and .87 for EWB (Genia, 2001).
Multidimensional Measure of Religiousness/Spirituality.
Two subscales from the Brief Multidimensional Measure of Religiousness/Spirituality (Idler et al., 2003) were administered: the
Daily Spiritual Experiences (DSE) subscale and the Positive Religious Coping subscale. These subscales were selected based on
prior research suggesting they reflect R/S domains that are more
relational in nature, indicative of a personal connection with a
Higher Power (Desrosiers, Kelley, & Miller, 2011; Desrosiers &
Miller, 2007).
The DSE subscale measures perception of experiencing a
Higher Power (i.e., God, a transcendent, universal force) in daily
life, with items focusing on experiential components of R/S, rather
than cognitions or behaviors. The six items comprised by the DSE
subscale measure degree of connection with a Higher Power, sense

of support and love received from a Higher Power, sense of

internal harmony, desire to be closer with a Higher Power, and
sense of awe. Item responses were recorded on a 6-point Likerttype scale, ranging from Many times per day to Never or almost
never. An exploratory principal components factor analysis with a
varimax rotation indicated that items loaded onto a single factor,
supporting the theoretical grouping of these items. The singlefactor structure explained 57% of the subscale variance. Item
factor loadings are presented in Table 2. This measure demonstrated adequate reliability, with a Cronbachs alpha coefficient of
.84. This is similar to Western samples, reporting coefficient of .91
for this subscale (Idler et al., 2003).
The Positive Religious Coping subscale is a measure of the
degree of R/S coping when faced with stressors or adversity. The
subscale consists of three items that measure the extent to which
understanding life as part of something larger, working together
with a Higher Power, and finding strength and guidance in R/S is
involved in coping responses. Responses were recorded on a
4-point Likert-type scale, ranging from Not at all to A great deal.
An exploratory principal components factor analysis with a varimax rotation indicated that items loaded onto a single factor,
supporting the theoretical grouping of these items. A single-factor
structure explained 56% of the scale variance. Item factor loadings
are presented in Table 2. In the current sample, the Cronbachs
alpha coefficient was .61. Previous samples have demonstrated
Cronbachs alpha coefficient of .81 (Idler et al., 2003) and .78
(Desrosiers & Miller, 2007).

Data Analysis
All analyses were conducted using version 22.0 of Statistics
Package for Social Science (SPSS). Individual items and scales
were assessed for outliers and distribution shape. Missing values
were imputed as mentioned above. Scales total scores were com-

Table 2
Loadings for Each DSE and PRC Item on Single Factor
DSE item
1.
2.
3.
4.
5.
6.

Feel Love
Desire to be Closer
Feel Presence
Religion Comfort
Awe Sense
Inner Harmony

Factor 1

PRC item

Factor 1

.856
.852
.796
.711
.664
.557

1. Part of Larger Force

2. Work Together
3. Strength

.779
.761
.712

Note. Columns represent two separate factor analyses. DSE Daily

Spiritual Experience; 1. Feel Love Item measuring the degree to which
individual feels Higher Powers love for them; 2. Desire to be Closer
Item measuring the degree to which individual desires to be closer to
Higher Power; 3. Feel Presence Item measuring the degree to which
individual feels Higher Powers presence in their lives; 4. Religion Comfort Item measuring the degree to which individual feels comforted by
their religion; 5. Awe Sense Item measuring the degree to which
individual feels a sense of awe; 6. Inner Harmony Item measuring the
degree to which individual feels inner peace or a sense of harmony (Idler
et al., 2003). PRC Positive Religious Coping Subscale; 1. Part of Larger
Force Extent to which think of your life is part of larger force in the way
you cope; 2. Work Together Extent to which you work together with
Higher Power in the way you cope; 3. Strength Extent to which you look
to Higher Power for strength and guidance in the way you cope (Idler et al.,
2003).

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

ACE AND R/S IN INDIAN ADOLESCENTS

puted and transformed to standardized scores for analyses. The use

of self-reports for data collection has been associated with Common Method Variance (CMC), or shared variance among variables
attributable to the use of similar measurement methods, which may
inflate the association between variables (Schaller, Patil, & Malhotra, 2015). CMC was assuaged by using different item response
scales for each measure and grouped individual items by measure,
rather than lumped into a string of items. Additionally, Harmans
single factor test failed to load study variables onto one factor.
Pearson r correlations and follow-up regression analyses were
conducted to assess the association between variables. A number
of correlations were found in this study, and the Bootstrapping
feature was used when conducting correlation analyses with 1,000
samples and a 95% confidence interval to increase our confidence
that significant correlations were not due to chance. Because of the
exploratory nature of the current study, the Bootstrapping technique of adjusting for multiple correlations was favored over the
Bonferroni correction, which has the potential to be excessively
conservative for exploratory analyses and inflate Type II error.
Gender differences were tested using independent samples t tests.
The small number of Christian and Muslim participants precluded
statistically testing for group differences and disallowed any meaningful presentation or discussion of data by religious group.

Results
Descriptive Statistics
Descriptive statistics of ACE scores for the total samples, as
well as boys and girls separately, are included in Table 1. Boys
endorsed more adversity categories (i.e., psychological/emotional
abuse, sexual abuse, psychological neglect, physical neglect, parents separated/divorced, witnessing domestic violence, household
member have a drug problem, household member with mental
illness, household member currently incarcerated) to a greater
degree than girl peers. Physical abuse was the only category that
boys and girls endorsed at a comparable rate, 18.3% and 18.2%,
respectively. Additionally, a greater percentage of boys endorsed
at least one ACE category (52.8%) compared to girls (33.3%).

Correlation Analyses
Pearson r correlations were computed to assess the relationship
between adverse childhood experiences and R/S domains. Analyses indicated a significant inverse relationship between existential
well-being and adverse childhood experiences, r .34, p .01.
Adverse childhood experiences were not significantly associated
with religious well-being, daily spiritual experiences, or positive
religious coping. Existential well-being was significantly associated with religious well-being, r .46, p .01, daily spiritual
experiences, r .26, p .01, and positive religious coping, r
.28, p .01. As expected, all R/S subscales were significantly
correlated with one another. Correlations among scales and subscales are presented in Table 3.
A separate Pearson r correlation was conducted to examine the
association between adversity score and the item of the daily
spiritual experiences subscale that specifically measures a desire to
be closer to a Higher Power (Hypothesis 3). Adversity was significantly correlated with desiring closeness, r .26, p .01. As

Table 3
Correlations Among Scales and Subscales
Measure
1.
2.
3.
4.
5.

EWB
RWB
DSE
PRC
ACE total score

.46
.26
.28
.34

.60
.55
.06

.48
.15

.04

Note. Spearman correlation coefficients are presented in the correlation

matrix. EWB Existential Well-Being; RWB Religious Well-Being
(Paloutzian & Ellison, 1982); DSE Daily Spiritual Experience; PRC
Positive Religious Coping (Idler et al., 2003); ACE Adverse Childhood
Experiences Scale (Felitti et al., 1998).

p .01.

indicated by the significantly positive relationship, higher reports

of adversity were associated with a greater desire to be closer to a
Higher Power.

Independent t Tests
Independent t tests were conducted to assess gender differences
within subscales. Significant gender differences were found for
religious well-being, t(131) 2.653, p .009, and existential
well-being, t(132) 3.892, p .001, with girls endorsing
higher scores on both subscales. Significant gender differences
were also found for adverse childhood experiences total scores,
t(124.755) 2.816, p .006; boys endorsed higher scores than
girls. No significant gender differences were found for daily spiritual experiences or positive religious coping. Means and standard
deviations for scales and subscales by gender are presented in
Table 4.

Regression Analyses
A series of regression analyses were conducted to test main
hypotheses. To test Hypothesis 1, a hierarchal univariate regression analysis was conducted, with ACE total scores used to predict
existential well-being. In Step one, age, gender, and religion were
entered as a set to control for potential confounding effects. In Step
two, ACE total scores were entered into the model as a predictor.
After controlling for age, gender, and religion, number of adverse
childhood experiences remained a significant predictor of existential well-being (B .25, p .01).
To test Hypothesis 3, a hierarchal univariate regression analysis
was conducted, with ACE total scores used to predict desire to be
closer to a Higher Power. In Step one, age, gender, and religion
were entered as a set to control for potential confounding effects.
In Step two, ACE total scores were entered into the model as a
predictor. After controlling for age, gender, and religion, number
of adverse childhood experiences remained a significant predictor
of a desire to be closer to a Higher Power (B .25, p .05).

Correlations and Regressions by Gender

As secondary analysis, Pearson r correlations were conducted
for boys and girls separately. ACE scores were significantly and
negatively correlated with existential well-being for girls,
r .37, p .01 but not boys, r .24, p .053. After

SANTORO ET AL.

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

controlling for age and religion, regression analysis indicated

higher scores on adverse childhood experiences remained a significant predictor of existential well-being for girls (B .48,
p .01). Similar to analyses using the total sample, the relationship between religious well-being and ACE did not reach significance for either boys or girls, separately. Although existential
well-being was significantly correlated with all R/S scales (i.e.,
religious well-being, daily spiritual experiences, and positive religious coping) for girls, existential well-being did not demonstrate
significance in relation to daily spiritual experiences and positive
religious coping for boys. In contrast to total sample and boys-only
analyses, a significant association was demonstrated between ACE
scores and positive religious coping for girls, r .32, p .05,
indicating higher reports of adversity were associated with a
greater degree of religious coping. Correlations by gender for
scales and subscales are presented in Table 5.
A separate correlation analysis was conducted to explore the
relationship between adversity and desire to connect with a Higher
Power by gender. Adversity was significantly linked to desire to
connect to a Higher Power in boys, r .33, p .01, but failed to
reach significance in girls, r .29, p .09. Follow-up regression
analyses revealed adversity significantly predicted desire to connect to a Higher Power in boys (B .33, p .05), even when
controlling for age and religion.

Exploratory Analyses
Considering the significant association between ACE scores and
positive religious coping for girls, exploratory analyses were conducted to explore the association between adversity and individual
items measuring positive religious coping. For girls, correlation
analyses demonstrated a significant association between adversity
total scores and positive religious coping item measuring working
together with a Higher Power as partners, r .31, p .05.
Although these results are exploratory, they suggest that childhood adversity may promote the development of differential approaches to spiritual domains based on gender. These gender
differences warrant future study.

Table 4
Mean Scores on Scales and Subscales by Gender
Measure
R/S subscales
Religious Well-Being
Existential Well-Being
Daily Spiritual Experiences
Positive Religious Coping
Childhood adversity and abuse
ACE total score

Girls M (SD) Boys M (SD) Total M (SD)

43.67 (10.32) 39.21 (9.06) 41.16 (9.86)
47.43 (8.30) 41.91 (8.07) 44.28 (8.65)
24.08 (7.38) 21.46 (7.35) 22.58 (7.47)
8.57 (2.35)
7.90 (2.34) 8.19 (2.36)
0.63 (1.22)

1.43 (1.97)

1.08 (1.71)

Note. Significant differences were noted between girls and boys. Girls
scored higher on spiritual well-being, whereas boys endorsed a greater
number of adverse childhood experiences. ACE Adverse Childhood
Experiences Scale (Felitti et al., 1998).

p .01.

Table 5
Correlations Among Scales and Subscales by Gender
Measure
1.
2.
3.
4.
5.

EWB
RWB
DSE
PRC
ACE Total Score

.37
.43
.40
.37

.43

.68
.63
.05

.02
.49

.74
.18

.11
.46
.22

.32

.24
.03
.20
.05

Note. Spearman correlation coefficients are presented below the diagonal

for girls and above the diagonal for boys. EWB Existential Well-Being;
RWB Religious Well-Being (Paloutzian & Ellison, 1982); DSE Daily
Spiritual Experience; PRC Positive Religious Coping (Idler et al., 2003);
ACE Adverse Childhood Experiences Scale (Felitti et al., 1998).

p .05. p .01.

Discussion
Childhood Adversity and R/S Domains
The current study shows that childhood adversity is a significant
predictor of existential well-being, among emerging adolescents in
India. Data also suggest a significant association between childhood adversity and ones desire to connect to a Higher Power.
Even after controlling for age, gender, and religion, higher incidences of adversity significantly predicted a greater desire to be
closer to a Higher Power. Of note, existential well-being in the
present study was measured as the sense of direction, purpose, and
meaning in life that relates to ones overall spiritual well-being
(Ellison, 1983). These data are consistent with studies from Western samples (e.g., Dervic et al., 2006; Reinert & Edwards, 2009)
indicating a strong inverse relationship between adverse experiences during childhood and well-being. To date, this is the first
study to replicate these findings in a non-Western sample of this
age group. Spiritual well-being in Western samples has been
shown to comprise religious and existential well-being (Ellison,
1983). Data from the current sample indicated that childhood
adversity had a stronger relationship with existential well-being
compared with religious well-being. The stronger relationship of
existential well-being with childhood adversity compared with
religious well-being may reflect a limitation of the measure of
spiritual well-being used in the current study. The Spiritual WellBeing scale was developed and normed on Judeo-Christian samples and may not capture the complexity of the religious experience within non-Christian samples. The current sample comprised
of Hindus and Muslims in addition to Christians. The measure
used may underestimate religious well-being in Eastern and non
Judeo-Christian emerging adolescents, because the expression of
religion is culturally bound (Leach, Piedmont, & Monteiro, 2001)
and the measure may not be sensitive to cultural nuances.
These data indicate a need to continue to assess validated R/S
measures on nonJudeo-Christian samples and develop research
tools that measure religious well-being in Hindu and Muslim
adolescents, as well as other religions, such as Buddhists, Jains,
and so forth. Admittedly, developing a universal tool may prove to
be an insurmountable task considering that religious well-being
may represent a distinct construct for each religious group across
the world. A related point regarding the measurement of the
religious experience within diverse cultures is that even Christians

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

ACE AND R/S IN INDIAN ADOLESCENTS

living in India may have imbibed certain elements of Hinduism in

the practices and beliefs and vice versa. Hence, religion and
culture are intimately entwined making the universal measurement
of spiritual well-being a significant challenge.
One final point regarding the measure used in the current study,
given the significant findings, is that it may be a good starting
point for developing a more nuanced measure. It is possible that
there are elements of the religious and spiritual experience that are
universal (e.g., belief in order in the universe) and other elements
that are more susceptible to cultural interpretation and expression
as well as individual preferences.
Regardless of the limitations of the measure, clearly these data
allude to the importance of spiritual connection in the face of
adversity. One possible reason for this inverse relationship between adversity and existential well-being may be reflective of the
impact of adversity on development, with uncertainty in ones
direction and purpose resulting from experiencing adversity in
youth. Most participants were around 13 years old; developmentally, it is around this time spiritual understanding is being integrated into personal identity (Burg et al., 2011). Additionally, a
sense of connection to a Higher Power may offer a source of
stability and security for youth who lack these components in their
everyday lives (Burg et al., 2011; Oman & Thoresen, 2006; Rao et
al., 2013; Rosmarin et al., 2011), and adversity may lead youth to
experience an increased desire for this sense of connection. Adversity during this critical time may enhance integration of spiritual values into personal frameworks. Indeed, data from adult
samples indicate that adversity leads to enhanced personal and
spiritual growth as people try to make sense of their experiences
(Harris, Leak, Dubke, & Voecks, 2015). During this point in
development, youth may still be in the process of making sense of
these experiences.
One possible speculative explanation of this inverse relationship
between adversity and well-being may be that under conditions of
adversity, reaching out to a larger existential reality helps in
making the adversity appear to be a small part of a much larger
whole. In other words, when you compare adversity to the minutiae of everyday life, it appears to be very significant; when that
same adversity is placed against a much larger, all-encompassing
spiritual reality, it appears of be much smaller in contrast. Perhaps
during adolescence these youth are still in the process of developing the perspective necessary to sublimate adversity, create meaning, and acknowledge personal resiliency.

Gender Differences: Adversity

Significant gender differences for both adverse childhood experiences and R/S domains were noted. Data revealed that boys in the
current sample reported more adverse experiences compared with
girls. When each domain of childhood adversity was examined, a
higher percentage of boys endorsed experiencing most categories
of adversity (e.g., psychological abuse, sexual abuse, psychological neglect, physical neglect, parental separation/divorce, witnessing domestic violence, and substance abuse, mental illness, and
incarceration of a household member) compared with girls. These
results are distinct from the literature on adverse childhood experiences in Western adults, where women generally reported a
greater total number of adverse experiences, including higher rates
of sexual abuse (Felitti et al., 1998). Physical abuse was the only

category in which boys and girls demonstrated similar reporting

rates, 18.3% and 18.2%, respectively, in the current sample. This
finding might be explained by the reduced sample size in conducting analyses for boys and girls separately. Studies with larger
sample sizes would better assess whether the present studys
findings reflect a small sample size or an actual negligible difference between boys and girls on reports of adverse experiences in
India.
One possibility to explain gender differences in rates of
adversity within this sample is that non-Western girls may be
less willing to report adverse experiences compared with their
male peers. It is noteworthy that data demonstrated comparable
rates of reporting physical abuse, which suggests that the
gender-specific reservation in reporting adversity may vary
among different categories of adverse experiences. Cultural
values in India strongly favor keeping family matters in the
home and not talking about personal information with people
outside the home. Hence, it is possible that all information in
this category is underreported.

Gender Differences: Religiosity/Spirituality

With regard to differences in R/S domains, girls in our sample
endorsed higher levels of existential and religious well-being,
compared with their male counterparts. These results are consistent
with other studies that report gender differences in spiritual domains (e.g., Desrosiers & Miller, 2007). Interestingly, current
analyses failed to find significant gender differences in daily
spiritual experiences or positive religious coping. Because of the
exploratory nature of the current study, it is unclear whether this
result is a reflection of a developmental characteristic of the age
group studied, a cultural nuance across the life span, a reflection of
our small sample size, or a limitation of the measure. Considering
that the majority of the current sample was 13 and 14 years old, it
is possible that more pronounced gender differences will manifest
as development continues. Future studies should examine these
constructs in Eastern samples to address these questions. Data
indicate that spirituality is positively associated with physical and
mental health and well-being (Brown et al., 2013; Burg et al.,
2011; Chattopadhyay, 2007; Desrosiers & Miller, 2007; McCullough et al., 2000; Oman & Thoresen, 2005; Oman & Thoresen, 2006; Powell, Shahabi, & Thoresen, 2003; Wachholtz &
Sambamoorthi, 2011). Future studies should examine whether
these gender differences also exist in the protective effects of
religiosity and spirituality in non-Western, adolescent populations.
Gender differences were noted in the relationship among R/S
domains. Analyses by gender demonstrated that existential wellbeing was significantly associated with other R/S domains (i.e.,
religious well-being, daily spiritual experiences, and positive religious coping) for girls; however, this was not true for boys. For
boys, existential well-being failed to demonstrate significance in
relation to daily spiritual experiences or positive religious coping.
These results indicate that the relational, experiential aspects of
R/S may influence well-being to a greater degree in girls compared
with boys. Although this finding needs to replicated in future
studies, it is consistent with the literature on Western adolescents
(Desrosiers et al., 2011; Desrosiers & Miller, 2007).

SANTORO ET AL.

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Gender Differences: Religiosity/Spirituality

and Adversity
Gender differences were found between adversity and R/S domains when analyses were conducted separately for boys and girls.
Adversity was significantly associated with a desire to connect to
a Higher Power in boys; however, this association failed to reach
significance in girls. Of note, this difference may be a reflection of
the sample size, as this relationship for girls was approaching
significance. Likewise, when examined in the total sample, the
relationship between adversity and increased desire to connect to a
Higher Power was strongly significant. Gender differences were
also demonstrated between adversity and positive religious coping,
with higher instances of adversity being associated with a greater
degree of religious coping for girls but not boys. For girls, adversity was a significant predictor of religious coping, specifically
working together with a Higher Power as partners in times of
stress. This suggests the ways girls and boys approach, understand,
and use R/S differently when faced with adversity and stress. Girls
may take a more personalized, relational approach than boys.

Considerations
There are several aspects to the current study that merit further
consideration. One consideration is the correlational design of this
study. Although this design limited making causal inferences, a
correlational approach is appropriate when exploring new territory,
such as how these constructs are related in a previously unexplored
cultures and age ranges. The second issue is that the data were
self-reported and included all the limitations associated with selfreported data. However, spiritual values are deeply personal and
self-reports may be the best way to access them. The third challenge was the small sample size, which limited appropriate statistical analyses including detailed exploration of gender differences
and precluded testing for religious group differences. Replications
of these results are needed from other non-Western samples. The
fourth consideration is that very few participants in this sample
identified as Christian. Although proportionately representative of
the religious distribution in India, a larger representative sample
should be studied to confirm results. Religious beliefs and practices are entwined with cultural beliefs and practices, which differ
not just all over the world but differ vastly even within India.
Future studies should explore these differences in non-Western
samples with a greater number of Christian participants. Finally,
the use of measures that were not developed on Indian or adolescent samples is an important limitation, and these measures may
not be sensitive to differences between populations. However,
these measures do provide a good starting point for the study of
religion and spiritual beliefs and their integration into the lives of
young people.

Conclusion
Data from this exploratory study indicate links between adversity and spirituality among young people in a developing country
(India). Adversity significantly predicted well-being even after
controlling for demographic variables. Additionally, higher instances of adversity predicted a greater desire to connect with a
Higher Power. On the one hand these data make intuitive sense, in

that India is a highly spiritual country and that young people from
the culture would reach out to their spiritual belief systems during
times of adversity. However, this study represents an effort to
collect data to verify this belief. These data also suggest an
intriguing possibility that needs to be explored in future research.
Given the link between adversity and spirituality, it is possible that
enhancing spiritual beliefs may actually buffer against adversity
and promote positive growth. Indeed research on posttraumatic
growth in the United States has pointed to the positive link between positive religious coping and growth (Gerber, Boals, &
Schuettler, 2011). It is possible that in India and other cultures like
India where spiritual beliefs are salient, this link may be mediated
by strong spiritual and existential beliefs.

References
Allen, K. R., & Brooks, J. E. (2012). At the intersection of sexuality,
spirituality, and gender: Young adults perceptions of religious beliefs in
the context of sexuality education. American Journal of Sexuality Education, 7, 285308. http://dx.doi.org/10.1080/15546128.2012.740859
Anda, R. F., Brown, D. W., Dube, S. R., Bremner, J. D., Felitti, V. J., &
Giles, W. H. (2008). Adverse childhood experiences and chronic obstructive pulmonary disease in adults. American Journal of Preventive
Medicine, 34, 396 403. http://dx.doi.org/10.1016/j.amepre.2008.02.002
Benson, P. L., Roehlkepartain, E. C., & Rude, S. P. (2003). Spiritual
development in childhood and adolescence: Toward a field of inquiry.
Applied Developmental Science, 7, 205213. http://dx.doi.org/10.1207/
S1532480XADS0703_12
Brown, D. R., Carney, J. S., Parrish, M. S., & Klem, J. L. (2013). Assessing
spirituality: The relationship between spirituality and mental health.
Journal of Spirituality in Mental Health, 15, 107122. http://dx.doi.org/
10.1080/19349637.2013.776442
Brown, I. T., Chen, T., Gehlert, N. C., & Piedmont, R. L. (2013). Age and
gender effects on the assessment of spirituality and religious sentiments
(ASPIRES) scale: A cross-sectional analysis. Psychology of Religion
and Spirituality, 5, 90 98. http://dx.doi.org/10.1037/a0030137
Bruce, A. J., Cooper, L. B., Kordinak, S. T., & Harman, M. J. (2011). God
and sin after 50: Gender and religious affiliation. Journal of Religion,
Spirituality, & Aging, 23, 224 235. http://dx.doi.org/10.1080/15528030
.2011.533400
Burg, S., Mayers, R. A., & Miller, L. J. (2011). Spirituality, religion and
healthy development in adolescents. In B. B. Brown & M. J. Prinstein
(Eds.), Encyclopedia of adolescence (Vol. 1, pp. 353359). San Diego,
CA: Academic Press. http://dx.doi.org/10.1016/B978-0-12-373951-3
.00042-9
Chatters, L. M. (2000). Religion and health: Public health research and
practice. Annual Review of Public Health, 21, 335367. http://dx.doi
.org/10.1146/annurev.publhealth.21.1.335
Chattopadhyay, S. (2007). Religion, spirituality, health and medicine: Why
should Indian physicians care? Journal of Postgraduate Medicine, 53,
262266. http://dx.doi.org/10.4103/0022-3859.33967
Cotton, S., McGrady, M. E., & Rosenthal, S. L. (2010). Measurement of
religiosity/spirituality in adolescent health outcomes research: Trends
and recommendations. Journal of Religion and Health, 49, 414 444.
http://dx.doi.org/10.1007/s10943-010-9324-0
Dervic, K., Grunebaum, M. F., Burke, A. K., Mann, J. J., & Oquendo,
M. A. (2006). Protective factors against suicidal behavior in depressed
adults reporting childhood abuse. Journal of Nervous and Mental Disease, 194, 971974. http://dx.doi.org/10.1097/01.nmd.0000243764
.56192.9c
Desrosiers, A., Kelley, B. S., & Miller, L. (2011). Parent and peer relationships and relational spirituality in adolescents and young adults.

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

ACE AND R/S IN INDIAN ADOLESCENTS

Psychology of Religion and Spirituality, 3, 39 54. http://dx.doi.org/
10.1037/a0020037
Desrosiers, A., & Miller, L. (2007). Relational spirituality and depression
in adolescent girls. Journal of Clinical Psychology, 63, 10211037.
http://dx.doi.org/10.1002/jclp.20409
Dube, S. R., Anda, R. F., Felitti, V. J., Edwards, V. J., & Croft, J. B.
(2002). Adverse childhood experiences and personal alcohol abuse as an
adult. Addictive Behaviors, 27, 713725. http://dx.doi.org/10.1016/
S0306-4603(01)00204-0
Dube, S. R., Fairweather, D., Pearson, W. S., Felitti, V. J., Anda, R. F., &
Croft, J. B. (2009). Cumulative childhood stress and autoimmune diseases in adults. Psychosomatic Medicine, 71, 243250. http://dx.doi.org/
10.1097/PSY.0b013e3181907888
Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda, R. F. (2003).
Relationship between multiple forms of childhood maltreatment and
adult mental health in community respondents: Results from the adverse
childhood experiences study. The American Journal of Psychiatry, 160,
14531460. http://dx.doi.org/10.1176/appi.ajp.160.8.1453
Eliason, M. J., Burke, A., van Olphen, J., & Howell, R. (2011). Complex
interactions of sexual identity, sex/gender, and religious/spiritual identity on substance use among college students. Sexuality Research and
Social Policy, 8, 117125. http://dx.doi.org/10.1007/s13178-011-0046-1
Ellison, C. W. (1983). Spiritual well-being: Conceptualization and
measurement. Journal of Psychology and Theology, 11, 330 340.
Retrieved from http://search.ebscohost.com/login.aspx?direct
true&dbpsyh&AN1991-14150-001&siteehost-live
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M.,
Edwards, V., . . . Marks, J. S. (1998). Relationship of childhood abuse
and household dysfunction to many of the leading causes of death in
adults. The Adverse Childhood Experiences (ACE) Study. American
Journal of Preventive Medicine, 14, 245258. http://dx.doi.org/10.1016/
S0749-3797(98)00017-8
Ganga, N. S., & Kutty, V. R. (2013). Influence of religion, religiosity and
spirituality on positive mental health of young people. Mental Health,
Religion & Culture, 16, 435 443. http://dx.doi.org/10.1080/13674676
.2012.697879
Genia, V. (2001). Evaluation of the spiritual well-being scale in a sample
of college students. International Journal for the Psychology of Religion, 11, 2533. http://dx.doi.org/10.1207/S15327582IJPR1101_03
Gerber, M. M., Boals, A., & Schuettler, D. (2011). The unique contributions of positive and negative religious coping to posttraumatic growth
and PTSD. Psychology of Religion and Spirituality, 3, 298 307. http://
dx.doi.org/10.1037/a0023016
Good, M., & Willoughby, T. (2008). Adolescence as a sensitive period for
spiritual development. Child Development Perspectives, 2, 3237. http://
dx.doi.org/10.1111/j.1750-8606.2008.00038.x
Harris, J. I., Leak, G. K., Dubke, R., & Voecks, C. (2015). Religious strain
and postconventional religiousness in trauma survivors. Psychology of
Religion and Spirituality, 7, 173178. http://dx.doi.org/10.1037/
rel0000026
Hillis, S. D., Anda, R. F., Dube, S. R., Felitti, V. J., Marchbanks, P. A., &
Marks, J. S. (2004). The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics, 113, 320 327. http://dx.doi.org/
10.1542/peds.113.2.320
Idler, E. L., Musick, M., Ellison, C. G., George, L. K., Krause, N., Ory,
M. G., . . . Williams, D. R. (2003). Measuring multiple dimensions of
religion and spirituality for health research. Research on Aging, 25,
327365. http://dx.doi.org/10.1177/0164027503025004001
Kattimani, S., Sarkar, S., Bharadwaj, B., & Rajkumar, R. P. (2014). An
exploration of the relationship between spirituality and state and trait
anger among medical students. Journal of Religion and Health. Advance
online publication. http://dx.doi.org/10.1007/s10943-014-9933-0

King, P. E., & Boyatzis, C. J. (2004). Exploring adolescent spiritual and

religious development: Current and future theoretical and empirical
perspectives. Applied Developmental Science, 8, 2 6. http://dx.doi.org/
10.1207/S1532480XADS0801_1
Larimore, W. L., Parker, M., & Crowther, M. (2002). Should clinicians
incorporate positive spirituality into their practices? What does the
evidence say? Annals of Behavioral Medicine, 24, 69 73. http://dx.doi
.org/10.1207/S15324796ABM2401_08
Leach, M. M., Piedmont, R. L., & Monteiro, D. (2001). Images of God
among Christians, Hindus, and Muslims in India. Research in the Social
Scientific Study of Religion, 12, 207226.
Lechner, C. M., Tomasik, M. J., Silbereisen, R. K., & Wasilewski, J.
(2013). Exploring the stress-buffering effects of religiousness in relation
to social and economic change: Evidence from Poland. Psychology of
Religion and Spirituality, 5, 145156. http://dx.doi.org/10.1037/
a0030738
Luquis, R. R., Brelsford, G. M., & Rojas-Guyler, L. (2012). Religiosity,
spirituality, sexual attitudes, and sexual behaviors among college students. Journal of Religion and Health, 51, 601 614. http://dx.doi.org/
10.1007/s10943-011-9527-z
McCullough, M. E., Hoyt, W. T., Larson, D. B., Koenig, H. G., &
Thoresen, C. (2000). Religious involvement and mortality: A metaanalytic review. Health Psychology, 19, 211222. http://dx.doi.org/
10.1037/0278-6133.19.3.211
Morgan, O. (2009). Thoughts on the interaction of trauma, addiction, and
spirituality. Journal of Addictions & Offender Counseling, 30, 515.
http://dx.doi.org/10.1002/j.2161-1874.2009.tb00052.x
Nieuwsma, J. A., Pepper, C. M., Maack, D. J., & Birgenheir, D. G. (2011).
Indigenous perspectives on depression in rural regions of India and the
United States. Transcultural Psychiatry, 48, 539 568. http://dx.doi.org/
10.1177/1363461511419274
Oman, D., & Thoresen, C. E. (2002). Does religion cause health?:
Differing interpretations and diverse meanings. Journal of Health Psychology, 7, 365380. http://dx.doi.org/10.1177/1359105302007004326
Oman, D., & Thoresen, C. E. (2005). Do religion and spirituality influence
health? In R. F. Paloutzian & C. L. Park (Eds.), Handbook of the
psychology of religion and spirituality (pp. 435 459). New York, NY:
Guilford.
Oman, D., & Thoresen, C. E. (2006). Religion, spirituality, and childrens
physical health. In E. C. Roehlkepartain, P. E. King, L. Wagener, & P. L.
Benson (Eds.), The handbook of spiritual development in childhood and
adolescence (pp. 399 416). Thousand Oaks, CA: Sage. http://dx.doi
.org/10.4135/9781412976657.n28
Paloutzian, R. F., & Ellison, C. W. (1982). Loneliness, spiritual well-being,
and the quality of life. In L. A. Peplau & D. Perlman (Eds.), Loneliness:
A sourcebook of current theory, research and therapy (pp. 224 237).
New York, NY: Wiley-Interscience.
Patel, C. J., Ramgoon, S., & Paruk, Z. (2009). Exploring religion, race and
gender as factors in life satisfaction and religiosity of young South
African adults. South African Journal of Psychology, 39, 266 274.
http://dx.doi.org/10.1177/008124630903900302
Piedmont, R. L., & Leach, M. M. (2002). Cross-cultural generalizability of
the spiritual transcendence scale in India: Spirituality as a universal
aspect of human experience. American Behavioral Scientist, 45, 1888
1901. http://dx.doi.org/10.1177/0002764202045012011
Powell, L. H., Shahabi, L., & Thoresen, C. E. (2003). Religion and
spirituality. Linkages to physical health. American Psychologist, 58,
36 52. http://dx.doi.org/10.1037/0003-066X.58.1.36
Ramiro, L. S., Madrid, B. J., & Brown, D. W. (2010). Adverse childhood
experiences (ACE) and health-risk behaviors among adults in a developing country setting. Child Abuse & Neglect, 34, 842 855. http://dx
.doi.org/10.1016/j.chiabu.2010.02.012
Rao, M. A., Berry, R., Gonsalves, A., Hastak, Y., Shah, M., & Roeser,
R. W. (2013). Globalization and the identity remix among urban ado-

This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

10

SANTORO ET AL.

lescents in India. Journal of Research on Adolescence, 23, 9 24. http://

dx.doi.org/10.1111/jora.12002
Reinert, D. F., & Edwards, C. E. (2009). Attachment theory, childhood
mistreatment, and religiosity. Psychology of Religion and Spirituality, 1,
2534.
Rosmarin, D. H., Pirutinsky, S., Auerbach, R. P., Bjrgvinsson, T., BigdaPeyton, J., Andersson, G., . . . Krumrei, E. J. (2011). Incorporating
spiritual beliefs into a cognitive model of worry. Journal of Clinical
Psychology, 67, 691700. http://dx.doi.org/10.1002/jclp.20798
Schaller, T. K., Patil, A., & Malhotra, N. K. (2015). Alternative techniques
for assessing common method variance: An analysis of the theory of
planned behavior research. Organizational Research Methods, 18, 177
206. http://dx.doi.org/10.1177/1094428114554398
Scott, E., Agresti, A., & Fitchett, G. (1998). Factor analysis of the spiritual
well-being scale and its clinical utility with psychiatric inpatients. Journal for the Scientific Study of Religion, 37, 314 321. http://dx.doi.org/
10.2307/1387530
Speaking Tree. (2011, March 5). God and I. The Times of India.
Retrieved October 9, 2013, from http://timesofindia.speakingtree.in/
spiritual-articles/god-and-i/God-And-I_14389
Speaking Tree Bureau. (2011, March 6). Young Indias spirit is about soul.
The Times of India. Retrieved from http://timesofindia.indiatimes.com/
life-style/Young-Indias-spirit-is-about-soul/articleshow/7637389.cms
Tarakeshwar, N. (2013). What does it mean to be a Hindu? A review of
common Hindu beliefs and practices and their implications for health. In

K. I. Pargament, J. J. Exline, & J. W. Jones (Eds.), APA handbook of

psychology, religion, and spirituality: Context, theory, and research
(Vol. 1, pp. 653 664). Washington, DC: American Psychological Association. http://dx.doi.org/10.1037/14045-036
Tarakeshwar, N., Pargament, K. I., & Mahoney, A. (2003). Measures of
Hindu pathways: Development and preliminary evidence of reliability
and validity. Cultural Diversity and Ethnic Minority Psychology, 9,
316 332. http://dx.doi.org/10.1037/1099-9809.9.4.316
Verma, S., & Saraswathi, T. S. (2002). Adolescents in India: Street urchins
or Silicon Valley millionaires? In B. B. Brown, R. W. Larson, & T. S.
Saraswathi (Eds.), The worlds youth: Adolescence in eight regions of
the globe (pp. 105140). New York, NY: Cambridge University Press.
Retrieved from http://books.google.com/books?idPjK6A8NMuCIC
Wachholtz, A., & Sambamoorthi, U. (2011). National trends in prayer use
as a coping mechanism for health concerns: Changes from 2002 to 2007.
Psychology of Religion and Spirituality, 3, 6777. http://dx.doi.org/
10.1037/a0021598
World Values Survey Association. (2009). World values survey 19812008
Official Aggregate v. 20090901. Madrid, Spain: Aggregate File Producer: ASEP/JDS. Retrieved from www.worldvaluessurvey.org

Received December 2, 2014

Revision received May 16, 2015
Accepted May 21, 2015