Abstract
We examined multiple dimensions of religiosity and their relationship to the four DSM-5 PTSD symptom clusters among US Veterans and Active Duty Military (ADM), hypothesizing that religiosity would be most strongly inversely related to negative cognitions/emotions (Criterion D symptoms) and less strongly to neurobiologically based symptom clusters (B, C, and E). This cross-sectional multisite study involved 591 Veterans and ADM from across the southern USA. Inclusion criteria were having served in a combat theater and the presence of PTSD symptoms. Measures of religious beliefs/practices, social involvement, and PTSD symptoms were administered, and bivariate and multivariate analyses were conducted in the overall sample, and in exploratory analyses, in the sample stratified by race (White, Black, and Hispanic). In the overall sample, multivariate analyses revealed that the only PTSD symptom cluster inversely related to religiosity was Criterion D, and only to organizational (b = − 0.08, P = 0.028) and cognitive/intrinsic religiosity (b = − 0.06, P = 0.049), relationships that were fully explained by social factors. Religious struggles, in contrast, were positively related to all four symptom clusters. Inverse relationships with Criterion D symptoms were particularly strong in Blacks, in whom inverse relationships were also present with Criterion E symptoms. In contrast, only positive relationships with PTSD symptom clusters were found in Hispanics, and no relationships (except for religious struggles) were present in Whites. As hypothesized, the inverse relationship between religious involvement and PTSD symptoms in Veterans and ADM was strongest (though modest) for Criterion D negative cognitions/emotions, especially in Blacks.
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References
Ali, M., Farooq, N., Bhatti, M. A., & Kuroiwa, C. (2012). Assessment of prevalence and determinants of posttraumatic stress disorder in survivors of earthquake in Pakistan using Davidson Trauma Scale. Journal of Affective Disorders, 136(3), 238–243.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5 ® ). Washington, DC: American Psychiatric Publishing.
Ashbaugh, A. R., Houle-Johnson, S., Herbert, C., El-Hage, W., & Brunet, A. (2016). Psychometric validation of the English and French versions of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). PLoS ONE, 11(10), e0161645.
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489–498.
Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., et al. (2016). Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (PCL-5) in veterans. Psychological Assessment, 28, 1379–1391.
Chan, C. S., & Rhodes, J. E. (2013). Religious coping, posttraumatic stress, psychological distress, and posttraumatic growth among female survivors four years after Hurricane Katrina. Journal of Traumatic Stress, 26, 257–265.
Currier, J. M., Drescher, K. D., & Harris, J. I. (2014). Spiritual functioning among veterans seeking residential treatment for PTSD: A matched control group study. Spirituality in Clinical Practice, 1(1), 3–15.
Currier, J. M., Foster, J. D., vanOyen Witvliet, C., Abernethy, A. D., Luna, L. M. R., Schnitker, S. A., et al. (2019). Spiritual struggles and mental health outcomes in a spiritually integrated inpatient program. Journal of Affective Disorders, 249, 127–135.
Currier, J. M., Holland, J. M., & Drescher, K. D. (2015). Spirituality factors in the prediction of outcomes of PTSD treatment for U.S. military veterans. Journal of Traumatic Stress, 28, 57–64.
Downey, R. G., & King, C. V. (1998). Missing data in Likert ratings: A comparison of replacement methods. Journal of General Psychology, 125(2), 175–191.
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.
Fenster, R. J., Lebois, L. A., Ressler, K. J., & Suh, J. (2018). Brain circuit dysfunction in post-traumatic stress disorder: From mouse to man. Nature Reviews Neuroscience, 19, 535–551.
Fontana, A., & Rosenheck, R. (2004). Trauma, change in strength of religious faith, and mental health service use among veterans treated for PTSD. Journal of Nervous and Mental Disease, 192(9), 579–584.
Ganocy, S. J., Goto, T., Chan, P. K., Cohen, G. H., Sampson, L., Galea, S., et al. (2016). Association of spirituality with mental health conditions in Ohio National Guard Soldiers. Journal of Nervous and Mental Disease, 204(7), 524–529.
Greenawalt, D. S., Tsan, J. Y., Kimbrel, N. A., Meyer, E. C., Kruse, M. I., Tharp, D. F., et al. (2011). Mental health treatment involvement and religious coping among African American, Hispanic, and white veterans of the wars of Iraq and Afghanistan. Depression Research and Treatment, article ID, 192186, 1–10.
Hoge, C. W., Riviere, L. A., Wilk, J. E., Herrell, R. K., & Weathers, F. W. (2014). The prevalence of post-traumatic stress disorder (PTSD) in US combat soldiers: a head-to-head comparison of DSM-5 versus DSM-IV-TR symptom criteria with the PTSD checklist. Lancet Psychiatry, 1, 269–277.
Kang, H. (2009). Analysis of VA health care utilization among US global war on terrorism (GWOT) Veterans: Unpublished report. Washington, DC: VHA Office of Public Health and Environmental Hazards.
Karl, A., Schaefer, M., Malta, L. S., Dörfel, D., Rohleder, N., & Werner, A. (2006). A meta-analysis of structural brain abnormalities in PTSD. Neuroscience and Biobehavioral Reviews, 30(7), 1004–1031.
Koenig, H. G. (2018). Religion and mental health: Research and clinical applications. San Diego: Academic Press.
Koenig, H. G., Ames, D., & Pearce, M. (2019). Religion and recovery from PTSD. London: Jessica Kingsley Publishers. in press.
Koenig, H. G., Ames, D., Youssef, N., Oliver, J. P., Volk, F., Teng, E. J., et al. (2018a). The moral injury symptom scale—military version. Journal of Religion and Health, 57, 249–265.
Koenig, H. G., Cohen, H. J., Blazer, D. G., Kudler, H. S., Krishnan, K. R. R., & Sibert, T. E. (1995). Religious coping and cognitive symptoms of depression in elderly medical patients. Psychosomatics, 36(4), 369–375.
Koenig, H. G., King, D. E., & Carson, V. B. (2012). Handbook of religion and health (2nd ed.). Oxford: Oxford University Press.
Koenig, H. G., Nelson, B., Shaw, S. F., Al Zaben, F., Wang, Z., & Saxena, S. (2015a). Belief into Action scale: A brief but comprehensive measure of religious commitment. Open Journal of Psychiatry, 5(1), 66–77.
Koenig, H. G., Wang, Z., Al Zaben, F., & Adi, A. (2015b). Belief into Action Scale: A comprehensive and sensitive measure of religious involvement. Religions, 6(3), 1006–1016.
Koenig, H. G., Youssef, N. A., Oliver, J. P., Ames, D., Haynes, K., Volk, F., et al. (2018b). Religious involvement, anxiety/depression, and PTSD symptoms in U.S. Veterans and Active Duty Military. Journal of Religion and Health, 57, 2325–2342.
Kopacz, M. S., Currier, J. M., Drescher, K. D., & Pigeon, W. R. (2016). Suicidal behavior and spiritual functioning in a sample of veterans diagnosed with PTSD. Journal of Injury and Violence research, 8(1), 6–14.
Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., et al. (1990). Trauma and the Vietnam war generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.
Malaktaris, A. L., & Lynn, S. J. (2018). The phenomenology and correlates of flashbacks in individuals with posttraumatic stress symptoms. Clinical Psychological Science. https://doi.org/10.1177/2167702618805081.
O’Doherty, D. C., Chitty, K. M., Saddiqui, S., Bennett, M. R., & Lagopoulos, J. (2015). A systematic review and meta-analysis of magnetic resonance imaging measurement of structural volumes in posttraumatic stress disorder. Psychiatry Research: Neuroimaging, 232(1), 1–33.
O’Doherty, D. C., Ryder, W., Paquola, C., Tickell, A., Chan, C., Hermens, D. F., et al. (2018). White matter integrity alterations in post-traumatic stress disorder. Human Brain Mapping, 39(3), 1327–1338.
Pargament, K. I., Smith, B. W., Koenig, H. G., & Perez, L. (1998). Patterns of positive and negative religious coping with major life stressors. Journal for the Scientific Study of Religion, 37(4), 710–724.
Pew Research Center. (2014). Racial and ethnic composition. U.S. Religious Landscape Study. Pew Research Center: Religion & Public Life. Retrieved February 18, 2019, from http://www.pewforum.org/religious-landscape-study/racial-and-ethnic-composition/.
Raines, A. M., Currier, J., McManus, E. S., Walton, J. L., Uddo, M., & Franklin, C. L. (2017). Spiritual struggles and suicide in veterans seeking PTSD treatment. Psychological Trauma, 9(6), 746–749.
Reynolds, N., Mrug, S., Hensler, M., Guion, K., & Madan-Swain, A. (2014). Spiritual coping and adjustment in adolescents with chronic illness: A 2-year prospective study. Journal of Pediatric Psychology, 39(5), 542–551.
Sharma, V., Marin, D. B., Koenig, H. K., Feder, A., Iacoviello, B. M., Southwick, S. M., et al. (2017). Religion, spirituality, and mental health of US military veterans: Results from the National Health and Resilience in Veterans Study. Journal of Affective Disorders, 217, 197–204.
Tait, R., Currier, J. M., & Harris, J. I. (2016). Prayer coping, disclosure of trauma, and mental health symptoms among recently deployed United States veterans of the Iraq and Afghanistan conflicts. International Journal for the Psychology of Religion, 26, 31–45.
Tanielian, T., & Jaycox, L. H. (Eds.). (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica: RAND Corporation.
Thabet, A., El-Buhaisi, O., & Vostanis, P. (2014). Trauma, PTSD, Anxiety, and coping strategies among Palestinians adolescents exposed to War on Gaza. Arab Journal of Psychiatry, 25(1), 71–82.
Trivedi, R. B., Post, E. P., Sun, H., Pomerantz, A., Saxon, A. J., Piette, J. D., et al. (2015). Prevalence, comorbidity, and prognosis of mental health among US veterans. American Journal of Public Health, 105(12), 2564–2569.
Tsai, J., El-Gabalawy, R., Sledge, W. H., Southwick, S. M., & Pietrzak, R. H. (2015). Post-traumatic growth among veterans in the USA: Results from the National Health and Resilience in Veterans Study. Psychological Medicine, 45(1), 165–179.
Tursich, M., Ros, T., Frewen, P. A., Kluetsch, R. C., Calhoun, V. D., & Lanius, R. A. (2015). Distinct intrinsic network connectivity patterns of post-traumatic stress disorder symptom clusters. Acta Psychiatrica Scandinavica, 132(1), 29–38.
Wortmann, J. H., Park, C. L., & Edmondson, D. (2011). Trauma and PTSD symptoms: Does spiritual struggle mediate the link? Psychological Trauma, 3(4), 442–452.
Acknowledgements
A special thanks to Kerry Haynes, D.Min., BCC, at the South Texas Veterans Healthcare System, 4318 Woodcock Dr #120, San Antonio, TX 78229, who collected the data from that site. This material is the result of work supported with resources and the use of facilities at the VA Greater Los Angeles Healthcare System (Los Angeles, CA), Charlie Norwood VA Medical Center (Augusta, GA), South Texas Veterans Healthcare System (San Antonio, TX), Michael E. DeBakey VA Medical Center (Houston, TX), and Durham Veterans Affairs Health Care System (Durham, NC).
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This work was funded by a grant received from the Augusta Biomedical Research Institute (Nagy Youssef), Augusta, GA, and by departmental funds from the Department of Counselor Education and Family Studies, School of Behavioral Sciences, Liberty University, Lynchburg, Virginia, and from the Center for Aging & Development, Duke University Medical Center, Durham, NC.
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The research conducted here was approved by the Institutional Review Boards (IRBs) and Research & Development Committees of the above VA Health Systems, Duke University Medical Center, and Liberty University.
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Koenig, H.G., Youssef, N.A., Ames, D. et al. Dimensions of Religiosity and PTSD Symptom Clusters in US Veterans and Active Duty Military. J Relig Health 58, 805–822 (2019). https://doi.org/10.1007/s10943-019-00817-7
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DOI: https://doi.org/10.1007/s10943-019-00817-7