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-BellEmail author
  • Andrew Miles
  • Matthew Toth
  • Christopher Adams
  • Bruce W. Smith
  • David Toole
Original Paper


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.


Depression Anxiety Clergy Effort-reward imbalance theory Mental health 



We wish to give special thanks to Laura A. Pratt, Ph.D., for conducting the PHQ-9 statistical analyses with the NHANES database. We thank Crystal MacAllum, Gail Thomas, Ed Mann, and their team at Westat for their superb data collection efforts, and Melanie Kolkin for her editorial skills. This research was funded by a grant from the Rural Church Area of The Duke Endowment.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Rae Jean Proeschold-Bell
    • 1
    Email author
  • 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

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