Annals of Behavioral Medicine

, Volume 50, Issue 6, pp 876–884 | Cite as

Religious Service Attendance and Lower Depression Among Women—a Prospective Cohort Study

  • Shanshan Li
  • Olivia I Okereke
  • Shun-Chiao Chang
  • Ichiro Kawachi
  • Tyler J. VanderWeeleEmail author
Original Article



Previous studies on the association between religious service attendance and depression have been mostly cross-sectional, subject to reverse causation, and did not account for the potential feedback between religious service attendance and depression. We prospectively evaluated evidence whether religious service attendance decreased risk of subsequent risk of depression and whether depression increased subsequent cessation of service attendance, while explicitly accounting for feedback with potential effects in both directions.


We included a total of 48,984 US nurses who were participants of the Nurses’ Health Study with mean age 58 years and who were followed up from 1996 to 2008. Religious service attendance was self-reported in 1992, 1996, 2000, and 2004. Depression was defined as self-reported physician-diagnosed clinical depression, regular anti-depressant use, or severe depressive symptoms. Multivariate logistic regression and marginal structural models were used to estimate the odds ratio of developing incident depression, adjusted for baseline religious service attendance, baseline depression, and time-varying covariates.


Compared with women who never attended services, women who had most frequent and recent religious service attendance had the lowest risk of developing depression (odds ratio [OR] = 0.71, 95 % confidence interval [CI] 0.62–0.82). Compared with women who were not depressed, women with depression were less likely to subsequently attend religious services once or more per week (OR = 0.74, 95 % CI 0.68–0.80).


In this study of US women, there is evidence that higher frequency of religious service attendance decreased the risk of incident depression and women with depression were less likely to subsequently attend services.


Religious service attendance Depression Causal models 



The study was support by the Templeton Foundation and National Institutes of Health grant R01 ES017876. The funding agencies played no role in the design and conduct of this study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Authors’ Contribution

SL and TJV contributed to the study design, data analysis, interpretation, and manuscript preparations. OIO, S-C C, and IK contributed to the study design and critical review of the manuscript. SL and TJV had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Authors Shanshan Li, Olivia I Okereke, Shun-Chiao Chang, Ichiro Kawachi, and Tyler J. VanderWeele declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Supplementary material

12160_2016_9813_MOESM1_ESM.doc (190 kb)
ESM 1 (DOC 190 kb)


  1. 1.
    Brundtland GH. From the World Health Organization. Mental health: new understanding, new hope. JAMA. 2001;286(19): 2391.Google Scholar
  2. 2.
    Blackburn–Munro G. Hypothalamo–pituitary–adrenal axis dysfunction as a contributory factor to chronic pain and depression. Curr Pain Headache Rep. 2004;8(2): 116–24.Google Scholar
  3. 3.
    Koenig HG. Religion, spirituality, and health: a review and update. Adv Mind Body Med. 2015;29(3): 19–26.Google Scholar
  4. 4.
    VanderWeele TJ. Religion and health: A synthesis. In: Peteet, JR and Balboni, MJ eds. Spirituality and Religion within the Culture of Medicine: From Evidence to Practice. New York, NY: Oxford University Press; 2016.Google Scholar
  5. 5.
    Mytko JJ, Knight SJ. Body, mind and spirit: towards the integration of religiosity and spirituality in cancer quality of life research. Psychooncology. 1999;8(5): 439–50.Google Scholar
  6. 6.
    Koenig HG. Depression in chronic illness: does religion help? J Christ Nurs Q Publ Nurs Christ Fellowship. 2014;31(1): 40–6.Google Scholar
  7. 7.
    McCullough ME, Larson DB. Religion and depression: a review of the literature. Twin Res. 1999;2(2): 126–36.Google Scholar
  8. 8.
    Hayward RD, Owen AD, Koenig HG, Steffens DC, Payne ME. Longitudinal relationships of religion with posttreatment depression severity in older psychiatric patients: evidence of direct and indirect effects. Depress Res Treat. 2012;745970.Google Scholar
  9. 9.
    Koenig HG. Religion and depression in older medical inpatients. Am J Geriatr Psychiatry. 2007;15(4): 282–91.Google Scholar
  10. 10.
    Koenig HG, Hays JC, George LK, Blazer DG, Larson DB, Landerman LR. Modeling the cross–sectional relationships between religion, physical health, social support, and depressive symptoms. Am J Geriatr Psychiatry. 1997;5(2): 131–44.Google Scholar
  11. 11.
    Rasic D, Kisely S, Langille DB. Protective associations of importance of religion and frequency of service attendance with depression risk, suicidal behaviours and substance use in adolescents in Nova Scotia, Canada. J Affect Disord. 2011;132(3): 389–95.Google Scholar
  12. 12.
    King DA, Lyness JM, Duberstein PR, He H, Tu XM, Seaburn DB. Religious involvement and depressive symptoms in primary care elders. Psychol Med. 2007;37(12): 1807–15.Google Scholar
  13. 13.
    Chatters LM, Bullard KM, Taylor RJ, Woodward AT, Neighbors HW, Jackson JS. Religious participation and DSM–IV disorders among older African Americans: findings from the National Survey of American Life. Am J Geriatr Psychiatry. 2008;16(12): 957–65.Google Scholar
  14. 14.
    Agorastos A, Demiralay C, Huber CG. Influence of religious aspects and personal beliefs on psychological behavior: focus on anxiety disorders. Psychol Res Behav Manag. 2014;7: 93–101.Google Scholar
  15. 15.
    Maselko J, Gilman SE, Buka S. Religious service attendance and spiritual well–being are differentially associated with risk of major depression. Psychol Med. 2009;39(6): 1009–17.Google Scholar
  16. 16.
    Koenig HG, McCullough ME, Larson DB. Handbook of Religion and Health. Oxford; New York Oxford University Press; 2001.CrossRefGoogle Scholar
  17. 17.
    Koenig HG, George LK, Peterson BL. Religiosity and remission of depression in medically ill older patients. Am J Psychiatry. 1998;155(4): 536–42.Google Scholar
  18. 18.
    Barton YA, Miller L, Wickramaratne P, Gameroff MJ, Weissman MM. Religious attendance and social adjustment as protective against depression: a 10–year prospective study. J Affect Disord. 2013;146(1): 53–7.Google Scholar
  19. 19.
    Barton YA, Miller L, Wickramaratne P, Gameroff MJ, Weissman MM. Religiosity and major depression in adults at high risk: a ten–year prospective study. Am J Psychiatry. 2012;169(1): 89–94.Google Scholar
  20. 20.
    Rasic D, Asbridge M, Kisely S, Langille D. Longitudinal associations of importance of religion and frequency of service attendance with depression risk among adolescents in Nova Scotia. Can J Psychiatry. 2013;58(5): 291–9.Google Scholar
  21. 21.
    Maselko J, Hayward RD, Hanlon A, Buka S, Meador K. Religious service attendance and major depression: a case of reverse causality? Am J Epidemiol. 2012;175(6): 576–83.Google Scholar
  22. 22.
    VanderWeele TJ. Re: “Religious service attendance and major depression: a case of reverse causality?” Am J Epidemiol. 2013;177(3): 275–6.Google Scholar
  23. 23.
    Belanger CF, Hennekens CH, Rosner B, Speizer FE. The Nurses’ Health Study. Am J Nurs. 1978;78(6): 1039–40.Google Scholar
  24. 24.
    Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES–D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10(2): 77–84.Google Scholar
  25. 25.
    Lyness JM, Noel TK, Cox C, King DA, Conwell Y, Caine ED. Screening for depression in elderly primary care patients. A comparison of the center for epidemiologic studies–depression scale and the geriatric depression scale. Arch Intern Med. 1997; 157(4): 449–54.Google Scholar
  26. 26.
    Friedman B, Heisel MJ, Delavan RL. Psychometric properties of the 15–item geriatric depression scale in functionally impaired, cognitively intact, community–dwelling elderly primary care patients. J Am Geriatr Soc. 2005;53(9):1570–6.Google Scholar
  27. 27.
    Blank K, Gruman C, Robison JT. Case–finding for depression in elderly people: balancing ease of administration with validity in varied treatment settings. J Gerontol Ser A Biol Sci Med Sci. 2004;59(4): M378–M84.Google Scholar
  28. 28.
    Robins JM, Hernan MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology (Cambridge, Mass.). 2000;11(5):550–560.Google Scholar
  29. 29.
    Ding P, and VanderWeele TJ. Sensitivity analysis without assumptions. Epidemiology. 2016;27(3):368–377.Google Scholar
  30. 30.
    Hadaway CK, Marler PL, Chaves M. What the polls don’t show: a closer look at U.S. Church attendance. Am Sociol Rev. 1993;58: 741–52.Google Scholar

Copyright information

© The Society of Behavioral Medicine 2016

Authors and Affiliations

  • Shanshan Li
    • 1
  • Olivia I Okereke
    • 2
    • 5
    • 6
  • Shun-Chiao Chang
    • 5
  • Ichiro Kawachi
    • 4
  • Tyler J. VanderWeele
    • 2
    • 3
    • 7
    Email author
  1. 1.Departments of NutritionHarvard T. H. Chan School of Public HealthBostonUSA
  2. 2.Department of EpidemiologyHarvard T. H. Chan School of Public HealthBostonUSA
  3. 3.Department of BiostatisticsHarvard T. H. Chan School of Public HealthBostonUSA
  4. 4.Department of Social and Behavioral SciencesHarvard T. H. Chan School of Public HealthBostonUSA
  5. 5.Department of Medicine, Channing Division of Network MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  6. 6.Department of PsychiatryHarvard Medical School and Brigham and Women’s HospitalBostonUSA
  7. 7.Program on Integrative Knowledge and Human FlourishingHarvard UniversityCambridgeUSA

Personalised recommendations