The Journal of Primary Prevention

, Volume 34, Issue 6, pp 439–453 | Cite as

Using Effort-Reward Imbalance Theory to Understand High Rates of Depression and Anxiety Among Clergy

  • Rae Jean Proeschold-Bell
  • Andrew Miles
  • Matthew Toth
  • Christopher Adams
  • Bruce W. Smith
  • David Toole
Original Paper

Abstract

The clergy occupation is unique in its combination of role strains and higher calling, putting clergy mental health at risk. We surveyed all United Methodist clergy in North Carolina, and 95 % (n = 1,726) responded, with 38% responding via phone interview. We compared clergy phone interview depression rates, assessed using the Patient Health Questionnaire (PHQ-9), to those of in-person interviews in a representative United States sample that also used the PHQ-9. The clergy depression prevalence was 8.7 %, significantly higher than the 5.5 % rate of the national sample. We used logistic regression to explain depression, and also anxiety, assessed using the Hospital Anxiety and Depression Scale. As hypothesized by effort-reward imbalance theory, several extrinsic demands (job stress, life unpredictability) and intrinsic demands (guilt about not doing enough work, doubting one’s call to ministry) significantly predicted depression and anxiety, as did rewards such as ministry satisfaction and lack of financial stress. The high rate of clergy depression signals the need for preventive policies and programs for clergy. The extrinsic and intrinsic demands and rewards suggest specific actions to improve clergy mental health.

Keywords

Depression Anxiety Clergy Effort-reward imbalance theory Mental health 

References

  1. Andrade, L., Caraveo-Anduaga, J. J., Berglund, P., Bijl, R. V., DeGraaf, R., Vollebergh, W., et al. (2003). The epidemiology of major depressive episodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. International Journal of Methods in Psychiatric Research, 12(1), 3–21.PubMedCrossRefGoogle Scholar
  2. Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52, 69–77.PubMedCrossRefGoogle Scholar
  3. Blanton, P. W., & Morris, M. L. (1999). Work-related predictors of physical symptomatology and emotional well-being among clergy and spouses. Review of Religious Research, 40(4), 331–348.CrossRefGoogle Scholar
  4. Blizzard, S. W. (1956). The minister’s dilemma. Christian Century, 73, 508–510.Google Scholar
  5. Bohnert, A. S. B., Perron, B. E., Jarman, C. N., Vaughn, M. G., Chatters, L. M., & Taylor, R. J. (2010). Use of clergy services among individuals seeking treatment for alcohol use problems. American Journal of Addictions, 19, 345–351.Google Scholar
  6. Bowling, A. (2005). Mode of questionnaire administration can have serious effects on data quality. Journal of Public Health, 27(3), 281–291.PubMedCrossRefGoogle Scholar
  7. Campbell, D. M. (1994). The call to ordained ministry. Who will go for us? An invitation to ordained ministry (pp. 26–59). Nashville: Abingdon Press.Google Scholar
  8. Carroll, J. W. (2006). God’s potters: Pastoral leadership and the shaping of congregations. Grand Rapids: William B. Eerdmans Pub.Google Scholar
  9. Cartwright, S., & Cooper, C. C. (Eds.). (2008). The Oxford handbook of organizational well-being. Oxford: Oxford University Press.Google Scholar
  10. Centers for Disease Control and Prevention. (2013). National Health and Nutrition Examination Survey. Retrieved July 29, 2013, from http://www.cdc.gov/nchs/nhanes.htm.
  11. Chatters, L. M., Mattis, J. S., Woodward, A. T., Taylor, R. J., Neighbors, H. W., & Grayman, N. A. (2011). Use of ministers for a serious personal problem among African Americans: Findings from the National Survey of American Life. American Journal of Orthopsychiatry, 81(1), 118–127.PubMedCrossRefGoogle Scholar
  12. Cohen, F. (1984). Coping. In J. D. Matarazzo, S. M. Weiss, J. A. Herd, N. E. Miller, & S. M. Weiss (Eds.), Behavioral health: A handbook of health enhancement and disease prevention. New York: Wiley.Google Scholar
  13. Crawford, J. R., Henry, J. D., Crombie, C., & Taylor, E. P. (2001). Normative data for the HADS from a large non-clinical sample. British Journal of Clinical Psychology, 40, 429–434.PubMedCrossRefGoogle Scholar
  14. Daly, E. J., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Gaynes, B. N., Warden, D., et al. (2010). Health-related quality of life in depression: A STAR*D report. Annals of Clinical Psychiatry, 22(1), 43–55.PubMedGoogle Scholar
  15. Darling, C. A., Hill, E. W., & McWey, L. M. (2004). Understanding stress and quality of life for clergy and clergy spouses. Stress & Health: Journal of the International Society for the Investigation of Stress, 20(5), 261–277.CrossRefGoogle Scholar
  16. Dewe, P. J. (1987). New Zealand ministers of religion: Identifying sources of stress and coping strategies. Work and Stress, 1(4), 351–363.CrossRefGoogle Scholar
  17. Eysenck, H. J., Barrett, P., Wilson, G., & Jackson, C. (1992). Primary trait measurement of the 21 components of the P-E-N system. European Journal of Psychological Assessment, 8(2), 109–117.Google Scholar
  18. Ferris, P. A., Kline, T. J. B., & Bourdage, J. S. (2012). He said, she said: Work, biopsychosocial, and lifestyle contributions to coronary heart disease risk. Health Psychology, 31(4), 503–511. doi:10.1037/a0026394.PubMedCrossRefGoogle Scholar
  19. Finke, R., & Dougherty, K. D. (2002). The effects of professional training: The social and religious capital acquired in seminaries. Journal for the Scientific Study of Religion, 41(1), 103–120.CrossRefGoogle Scholar
  20. Frame, M. W., & Shehan, C. L. (1994). Work and well-being in the two-person career: Relocation stress and coping among clergy husbands and wives. Family Relations, 43(2), 196–205.CrossRefGoogle Scholar
  21. Frenk, S. M., Mustillo, S. A., Hooten, E. G., & Meador, K. G. (2011). The Clergy Occupational Distress Index (CODI): Background and findings from two samples of clergy. Journal of Religion and Health,. doi:10.1007/s10943-011-9486-4.PubMedGoogle Scholar
  22. Glanz, K., & Schwartz, M. D. (2008). Stress, coping, and health behavior. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research and practice (4th ed., pp. 211–236). San Francisco: Jossey-Bass.Google Scholar
  23. Gleason, J. J. (1977). Perception of stress among clergy and their spouses. The Journal of Pastoral Care, 31, 448–452.Google Scholar
  24. Grosch, W. N., & Olson, D. C. (2000). Clergy burnout: An integrative approach. Journal of Clinical Psychology, 56(5), 619–632.PubMedCrossRefGoogle Scholar
  25. Jones, S. H., Francis, L. J., & Jackson, C. (2004). The relationship between religion and anxiety: A study among Anglican clergymen and clergywomen. Journal of Psychology & Theology, 32(2), 137–142.Google Scholar
  26. Kay, W. K. (2000). Role conflict and British Pentecostal ministers. Journal of Pyschology and Theology, 28(2), 119–124.Google Scholar
  27. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., et al. (2003). The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association, 289(23), 3095–3105. doi:10.1001/jama.289.23.3095.PubMedCrossRefGoogle Scholar
  28. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.PubMedCrossRefGoogle Scholar
  29. Klinkman, M. S., Coyne, J. C., Gallo, S., & Schwenk, T. L. (1997). Can case-finding instruments be used to improve physician detection of depression in primary care? Archives of Family Medicine, 6(6), 567–573.PubMedCrossRefGoogle Scholar
  30. Knox, S., Virginia, S. G., & Lombardo, J. P. (2002). Depression and anxiety in Roman Catholic secular clergy. Pastoral Psychology, 50(5), 345–358.CrossRefGoogle Scholar
  31. Knox, S., Virginia, S. G., & Smith, J. (2007). Pilot study of psychopathology among Roman Catholic secular clergy. Pastoral Psychology, 55(3), 297–306.CrossRefGoogle Scholar
  32. Knox, S., Virginia, S. G., Thull, J., & Lombardo, J. P. (2005). Depression and contributors to vocational satisfaction in Roman Catholic secular clergy. Pastoral Psychology, 54(2), 139–153.CrossRefGoogle Scholar
  33. Krause, N., Ellison, C. G., & Wulff, K. M. (1998). Church-based emotional support, negative interaction, and psychological well-being: Findings from a national sample of Presbyterians. Journal for the Scientific Study of Religion, 37(4), 725–741.CrossRefGoogle Scholar
  34. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.PubMedCrossRefGoogle Scholar
  35. Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317–325.PubMedCrossRefGoogle Scholar
  36. Kuhne, G. W., & Donaldson, J. F. (1995). Balancing ministry and management: An exploratory study of pastoral work activities. Review of Religious Research, 37(2), 147–163.CrossRefGoogle Scholar
  37. Lagerveld, S. E., Bültmann, U. U., Franche, R. L., van Dijk, F. H., Vlasveld, M. C., van der Feltz-Cornelis, C. M., et al. (2010). Factors associated with work participation and work functioning in depressed workers: A systematic review. Journal of Occupational Rehabilitation, 20(3), 275–292. doi:10.1007/s10926-009-9224-x.PubMedCrossRefGoogle Scholar
  38. Lee, C., & Iverson-Gilbert, J. (2003). Demand, support, and perception in family-related stress among Protestant clergy. Family Relations, 52(3), 249–257.CrossRefGoogle Scholar
  39. Lerner, D., Adler, D. A., Rogers, W. H., Chang, H., Lapitsky, L., McLaughlin, T., et al. (2010). Work performance of employees with depression: The impact of work stressors. American Journal of Health Promotion, 24(3), 205–213.PubMedCrossRefGoogle Scholar
  40. Lerner, D., & Henke, R. (2008). What does research tell us about depression, job performance, and work productivity? Journal of Occupational and Environmental Medicine, 50(4), 401–410.PubMedCrossRefGoogle Scholar
  41. Mendlowicz, M. V., & Stein, M. B. (2000). Quality of life in individuals with anxiety disorders. American Journal of Psychiatry, 157(5), 669–682. doi:10.1176/appi.ajp.157.5.669.PubMedCrossRefGoogle Scholar
  42. Miles, A., & Proeschold-Bell, R. J. (2012). Are rural clergy worse off? An examination of occupational conditions and pastoral experiences in a sample of United Methodist clergy. Sociology of Religion: A Quarterly Review, 73(1), 23–45. doi:10.1093/socrel/srr025.CrossRefGoogle Scholar
  43. Milstein, G., Kennedy, G. J., Bruce, M. L., Flannelly, K., Chelchowski, N., & Bone, L. (2005). The clergy’s role in reducing stigma: Elder patients’ views. World Psychiatry, 4(S1), 26–32.Google Scholar
  44. Mirowsky, J., & Ross, C. E. (1992). Age and depression. Journal of Health and Social Behavior, 33(3), 187–205.PubMedCrossRefGoogle Scholar
  45. Morris, M. L., & Blanton, P. (1998). Predictors of family functioning among clergy and spouses: Influences of social context and perceptions of work-related stressors. Journal of Child and Family Studies, 7, 27–41.CrossRefGoogle Scholar
  46. Musson, D. J. (1998). The personality profile of male Anglican clergy in England: The 16PF. Personality and Individual Differences, 25(4), 689–698.CrossRefGoogle Scholar
  47. National Center for Health Statistics. (2012). Prevalence of current depression among persons aged ≥ 12 years, by age group and sex—United States, National Health and Nutrition Examination Survey, 2007–2010. Morbidity and Mortality Weekly Report, 60(51, 52), 1747.Google Scholar
  48. Niebuhr, H. R. (1957). The purpose of the church and its ministry. New York: Harper & Row.Google Scholar
  49. Noller, P. (1984). Clergy marriages: A study of a uniting church sample. Austrailian Journal of Sex, Marriage and Family, 5, 187–197.Google Scholar
  50. Pallone, N., & Banks, R. (1968). Vocational satisfaction among ministerial students. Personnal & Guidance Journal, 46, 870–875.CrossRefGoogle Scholar
  51. Pargament, K. I., & Mahoney, A. (2005). Theory: Sacred matters: Sanctification as a vital topic for the psychology of religion. International Journal for the Psychology of Religion, 15(3), 179–198.CrossRefGoogle Scholar
  52. Peirce, R. S., Frone, M. R., Russell, M., & Cooper, M. L. (1994). Relationship of financial strain and psychosocial resources to alcohol use and abuse: The mediating role of negative affect and drinking motives. Journal of Health and Social Behavior, 35(4), 291–308.PubMedCrossRefGoogle Scholar
  53. Perl, P., & Chang, P. M. Y. (2000). Credentialism across creeds: Clergy education and stratification in protestant denominations. Journal for the Scientific Study of Religion, 39(2), 171–188.CrossRefGoogle Scholar
  54. Pratt, L. A., & Brody, D. J. (2008). Depression in the United States household population, 2005–2006. NCHS Data Brief, 7, 1–7.PubMedGoogle Scholar
  55. Proulx, W. A. (2008). Depressive symptoms among members of the clergy serving on the New Mexico district of the Church of the Nazarene in the United States. Dissertation Abstracts International Section A: Humanities and Social Sciences, 69(6-A), 2315.Google Scholar
  56. R Development Core Team. (2011). R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing.Google Scholar
  57. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.CrossRefGoogle Scholar
  58. Rayburn, C. A., Richmond, L. J., & Rogers, L. (1986). Men, women, and religion: Stress within leadership roles. Journal of Clinical Psychology, 42(3), 540–546.PubMedCrossRefGoogle Scholar
  59. Schnall, P. L., Dobson, M., Rosskam, E., Baker, D., & Landsbergis, P. (Eds.). (2008). Unhealthy work: Causes, consequences and cures. Amityville: Baywood Press.Google Scholar
  60. Shirom, A., Toker, S., Alkaly, Y., Jacobson, O., & Balicer, R. (2011). Work-based predictors of mortality: A 20-year follow-up of healthy employees. Health Psychology, 30(3), 268–275.PubMedCrossRefGoogle Scholar
  61. Siegrist, J. (1996). Adverse health effects of high effort/low-reward conditions. Journal of Occupational Health Psychology, 1(1), 27–41.PubMedCrossRefGoogle Scholar
  62. Siegrist, J., & Matschinger, H. (1989). Restricted status control and cardiovascular risk. In A. Steptoe & A. Appels (Eds.), Stress, personal control and health (pp. 65–82). Chichester: Wiley.Google Scholar
  63. Spielberger, C. D., Gorsuch, R. L., Lushene, P. R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the state-trait anxiety inventory (Form Y). Palo Alto: Consulting Psychologists Press, Inc.Google Scholar
  64. Spitzer, R. L., Kroenke, K., Williams, J. B., & The Patient Health Questionnaire Primary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Journal of the American Medical Association, 282(18), 1737–1744.Google Scholar
  65. Stewart-Sicking, J. A. (2012). Subjective well-being among Episcopal priests: Predictors and comparisons to non-clinical norms. Journal of Prevention & Intervention in the Community, 40(3), 180–193.Google Scholar
  66. Stewart-Sicking, J. A., Ciarrocchi, J. W., Hollensbe, E. C., & Sheep, M. L. (2011). Workplace characteristics, career/vocation satisfaction, and existential well-being in Episcopal clergy. Mental Health, Religion & Culture, 14(7), 715–730.CrossRefGoogle Scholar
  67. Stordal, E., Krüger, M. B., Dahl, N. H., Krüger, Ø., Mykletun, A., & Dahl, A. A. (2001). Depression in relation to age and gender in the general population: The Nord-Trøndelag Health Study (HUNT). Acta Psychiatrica Scandinavica, 104(3), 210–216.PubMedCrossRefGoogle Scholar
  68. SUDAAN. (2008). SUDAAN Release 10. RTP: RTI International.Google Scholar
  69. US Department of Labor. (2012). Occupational outlook handbook, 2012–2013 edition. Retrieved April 25, 2012, from http://www.bls.gov/ooh/home.htm.
  70. US Department of Labor. (2013). Employment projections: Education and training. Retrieved April 3, 2013, from http://www.bls.gov/emp/ep_chart_001.htm.
  71. Wang, P. S., Berglund, P. A., & Kessler, R. C. (2003). Patterns and correlates of contacting clergy for mental disorders in the United States. Health Services Research, 38(2), 647–673.PubMedCrossRefGoogle Scholar
  72. Weaver, A. J. (1995). Has there been a failure to prepare and support parish-based clergy in their role as front-line community mental health workers? A review. The Journal of Pastoral Care, 49, 129–149.Google Scholar
  73. Weaver, A. J., Larson, D., Flannelly, K., Stapleton, C., & Koenig, H. (2002). Mental health issues among clergy and other religious professionals: A review of research. The Journal of Pastoral Care & Counseling, 56, 393–403.Google Scholar
  74. Weiner, H. (1992). Perturbing the organism: The biology of stressful experience. Chicago: Chicago University Press.Google Scholar
  75. Wong, M., Sakisian, C., Davis, C., Kinsler, J., & Cunningham, W. (2006). The association between life chaos, health care use, and health status among HIV-infected persons. Journal of General Internal Medicine, 22, 1286–1291.CrossRefGoogle Scholar
  76. Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Rae Jean Proeschold-Bell
    • 1
  • Andrew Miles
    • 2
  • Matthew Toth
    • 3
  • Christopher Adams
    • 4
  • Bruce W. Smith
    • 5
  • David Toole
    • 6
  1. 1.Duke Global Health Institute, Center for Health Policy and Inequalities ResearchDuke UniversityDurhamUSA
  2. 2.Department of SociologyDuke UniversityDurhamUSA
  3. 3.Gillings School of Global Public HealthUniversity of North Carolina Chapel HillChapel HillUSA
  4. 4.Division of Student Life, Office of the Campus Pastors, Graduate Department of PsychologyAzusa Pacific UniversityAzusaUSA
  5. 5.Department of PsychologyUniversity of New MexicoAlbuquerqueUSA
  6. 6.Duke Divinity SchoolDuke UniversityDurhamUSA

Personalised recommendations