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September 2009 Article of the Month
This month's article selection is by Chaplain John Ehman,
University of Pennsylvania Medical Center-Penn Presbyterian, Philadelphia PA.


Murphy, P. E. and Fitchett, G. "Belief in a concerned God predicts response to treatment for adults with clinical depression." Journal of Clinical Psychology 65, no. 9 (September 2009): 1000-1008.


SUMMARY and COMMENT: This month's article is a collaboration between Patricia E. Murphy and George Fitchett from the Research Division of the Department of Religion, Health and Human Values at the Rush University College of Health Sciences and the Rush University Medical Center. They write: "Our study was interested in whether or not turning to religious belief in a concerned God effects response to treatment for those diagnosed with clinical depression" [p. 1001]. They build upon a 2000 study [Murphy, P. E., et al., "The relation of religious belief and practices, depression, and hopelessness in persons with clinical depression," noted below in Related Items of Interest, #1] to hypothesize both "that greater baseline belief in a concerned and supportive God would be positively associated with greater likelihood of response to treatment for depression" and "that hopelessness would mediate the impact of these religious beliefs on response to treatment" [p. 1001] --and the data here supports the former, though not the latter. What may be of particular interest to chaplains is the conceptualization of "belief in a concerned God," as assessed by the Religious Well-Being (RWB) subscale of the (Paloutzian & Ellison) Spiritual Well-Being Scale (SWBS).

This is "one of a few studies with participants diagnosed with clinical depression with a longitudinal outcome indicating the impact of religion" [p. 1006], and 136 patients provided information at baseline (shortly after admission for treatment) and eight weeks later. In addition to the Religious Well-Being (RWB) subscale of the Spiritual Well-Being Scale, patients were asked to complete the Beck Hopelessness Scale and the Beck Depression Inventory. Response to treatment was defined as "at least a 50% reduction in symptoms" [p. 1002]. Among the results, "those with strong beliefs in a personal and concerned God have an increased likelihood of response to treatment for depression" [p. 1004]. According to one model in the analysis,

The odds ratio for RWB...indicates that for a unit increase in RWB, there is a 5% greater likelihood of responding to treatment. Compared to those with scores in the lower third for RWB, persons in the upper third of RWB were 75% more likely to respond to treatment. [p. 1004]
The authors speculate:
Perhaps...belief in an understanding being who accepts us unconditionally provides healing and support for those locked in the isolation of depression. There is evidence that symptoms of depression are related to social support.... The measure of religious belief in our current study includes an aspect of support from a concerned God. [p. 1004]
They further note: "Another perspective on the results of our study is that low RWB scores might indicate a loss of belief or religious the face of symptoms, which would add to a patientís distress" [p. 1006]. (Fitchett, Murphy, and others authored an important study on religious struggle that was featured as our November 2004 Article of the Month.)

This research did not find that baseline hopelessness mediated belief in a caring God, "because it was not a significant predictor of response to treatment." [p. 1004]. The authors suggest that this may have been due to the sample size, and they encourage more research in this area [--see p. 1006].

Of special interest for chaplains is the use of the RWB subscale of the SWBS to measure "belief in a concerned God." The SWBS has 20 items, 10 of which contain the word God and constitute the RWB subscale. In these instances, the formulations of the items either explicitly or implicitly suggest a dynamic of personal and active relationship with God, with 7 items phrased positively (e.g., "I believe that God is concerned about my problems") and 3 negatively (e.g., "I believe that God is impersonal and not interested in my daily situations"). Validation testing of the RWB subscale has indicated "a positive correlation with intrinsic religious orientation...and a negative association with a loneliness scale" [--see p. 1003]. The SWBS is well established in the religion & health literature, and it deserves continued attention not only by researchers but by clinical chaplains exploring religious/spiritual assessment strategies. [Note: The other subscale in the SWBS is intended to measure Existential Well-Being and includes items that need not necessarily apply to theists (e.g., "I feel that life is a positive experience" and "I feel unsettled about my future").]

Murphy and Fitchett are as careful in their writing as they are in their research, and they point out that the results here "support, but do not prove that belief in a caring and concerned God plays a role in response to treatment for people diagnosed with depression" [p. 1006]; yet their work makes another persuasive case for clinicians' attention to patients' religious/spiritual beliefs. Chaplains may find this study useful in engaging physicians treating depressed patients.


Suggestions for the Use of the Article for Discussion in CPE: 

This month's article may be suited more to students experienced in reading research than to those new to the literature -- the Data Analysis section, for instance, is highly technical -- but the introductory material and the basic findings should provide ample material for general discussion. What are the possible health implications of a patient's belief in a concerned God? What might be the underlying associations between such a belief and one's sense of self, relationship with others, and view of the nature of life? Some religious traditions emphasize a personal relationship with God more than others do, so how might that dynamic affect the importance of a belief in a personal God in health care situations? The article could lead to a wider discussion of how belief in a concerned God may play into the concept of Religious Well-Being, and students might want to explore further the (Paloutzian & Ellison) Spiritual Well-Being Scale. [For other studies using the SWBS, see the March 2004 Articles-of-the-Month page.


Related Items of Interest:

I. The 2000 study which served as a basis for the present research is:

Murphy, P. E., Ciarrocchi, J. W., Piedmont, R. L., Cheston, S., Peyrot, M. and Fitchett, G. "The relation of religious belief and practices, depression, and hopelessness in persons with clinical depression." Journal of Consulting and Clinical Psychology 68, no. 6 (December 2000): 1102-1106. [(Abstract:) Religious belief and practices have been associated with lower levels of depression in persons dealing with stressful situations. In this study, researchers examined this relationship in 271 persons diagnosed with clinical depression. It was hypothesized that religious belief and practices would be associated with lower depression and that this relationship would be mediated by hopelessness. Religious belief, but not religious behavior, was a significant predictor of lower levels of hopelessness and depression beyond demographic variables. Through the relation of religious belief to lower levels of hopelessness, religious belief was indirectly related to less depression. There was also a small direct positive association of belief with depression, pointing to the complexity of the role belief plays for religious persons. Further study is needed for a better understanding of different ways religion affects depressed persons.]

II. In addition to the very good bibliography of this month's article, see the following recent articles on spirituality and depression that also use the (Paloutzian & Ellison) Spiritual Well-Being Scale:

Dalmida, S. G., Holstad, M. M., Diiorio, C. and Laderman, G. "Spiritual well-being, depressive symptoms, and immune status among women living with HIV/AIDS." Women and Health 49, nos. 2-3 (March-May 2009): 119-143. [(Abstract:) Spirituality is a resource some HIV-positive women use to cope with HIV, and it also may have positive impact on physical health. This cross-sectional study examined associations of spiritual well-being, with depressive symptoms, and CD4 cell count and percentages among a non-random sample of 129 predominantly African-American HIV-positive women. Significant inverse associations were observed between depressive symptoms and spiritual well-being (r = -.55, p = .0001), and its components, existential well-being (r = -.62, p = .0001) and religious well-being (r = -.36, p = .0001). Significant positive associations were observed between existential well-being and CD4 cell count (r = .19, p < .05) and also between spiritual well-being (r = .24, p < .05), religious well-being (r = .21, p < .05), and existential well-being (r = .22, p < .05) and CD4 cell percentages. In this sample of HIV-positive women, spiritual well-being, existential well-being, and religious well-being accounted for a significant amount of variance in depressive symptoms and CD4 cell percentages, above and beyond that explained by demographic variables, HIV medication adherence, and HIV viral load (log). Depressive symptoms were not significantly associated with CD4 cell counts or percentages. A significant relationship was observed between spiritual/religious practices (prayer/meditation and reading spiritual/religious material) and depressive symptoms. Further research is needed to examine relationships between spirituality and mental and physical health among HIV-positive women.]

Dunn, L. L. and Shelton, M. M. "Spiritual well-being, anxiety, and depression in antepartal women on bedrest." Issues in Mental Health Nursing 28, no. 11 (November 2007): 1235-1246. [(Abstract:) This descriptive correlational study examined relationships among anxiety, depression, and spiritual well-being (SWB) in three groups of women (non-pregnant, normal pregnancy, high-risk pregnancy on bedrest). Women in each group completed a demographic survey, a Spiritual Well-Being Scale, and depression and anxiety subscales from the Abbreviated Scale for the Assessment of Psychosocial Status in Pregnancy. All groups (N = 180) demonstrated significant, inverse relationships among SWB, anxiety, and depression. Findings emphasize the importance of obstetrical nurses screening pregnant women to evaluate emotional health, especially in high risk pregnancies. Collaboration with mental health nurses may be useful in developing interventions to improve a woman's SWB, reduce anxiety and depression, and improve pregnancy outcomes.]

Maselko, J., Gilman, S. E. and Buka, S. "Religious service attendance and spiritual well-being are differentially associated with risk of major depression." Psychological Medicine 39, no. 6 (June 2009): 1009-1017. [(Abstract:) BACKGROUND: The complex relationships between religiosity, spirituality and the risk of DSM-IV depression are not well understood. METHOD: We investigated the independent influence of religious service attendance and two dimensions of spiritual well-being (religious and existential) on the lifetime risk of major depression. Data came from the New England Family Study (NEFS) cohort (n=918, mean age=39 years). Depression according to DSM-IV criteria was ascertained using structured diagnostic interviews. Odds ratios (ORs) for the associations between high, medium and low tertiles of spiritual well-being and for religious service attendance and the lifetime risk of depression were estimated using multiple logistic regression. RESULTS: Religious service attendance was associated with 30% lower odds of depression. In addition, individuals in the top tertile of existential well-being had a 70% lower odds of depression compared to individuals in the bottom tertile. Contrary to our original hypotheses, however, higher levels of religious well-being were associated with 1.5 times higher odds of depression. CONCLUSIONS: Religious and existential well-being may be differentially associated with likelihood of depression. Given the complex interactions between religiosity and spirituality dimensions in relation to risk of major depression, the reliance on a single domain measure of religiosity or spirituality (e.g. religious service attendance) in research or clinical settings is discouraged.]

III. Regarding the Spiritual Well-Being Scale itself, visit Other articles using this scale (thought not necessarily in studies of depression) can be found on our March 2004 Articles-of-the-Month page.

IV. For more on spirituality and depression in general (not necessarily involving measures of well-being), see our August 2007 Articles-of-the-Month page.

V. For more on research conducted by Patricia E. Murphy, George Fitchett, and others in the Research Division of the Rush University College of Health Sciences and the Rush University Medical Center, see the Areas of Research section of the department's website.


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