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



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.

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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.

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Corresponding author

Correspondence to Tyler J. VanderWeele PhD.

Ethics declarations

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.

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Li, S., Okereke, O.I., Chang, S. et al. Religious Service Attendance and Lower Depression Among Women—a Prospective Cohort Study. ann. behav. med. 50, 876–884 (2016).

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  • Religious service attendance
  • Depression
  • Causal models