Skip to main content
Log in

The Role of Spirituality in the Relationship Between Religiosity and Depression in Prostate Cancer Patients

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Purpose

This study aims to develop a theoretical framework of the relationship among religiosity, spirituality, and depression, potentially explaining the often mixed and inconsistent associations between religiosity and depression.

Methods

In this cross-sectional study, 367 men (average age of 66 ± 9 years) with prostate cancer completed measures of religiosity (extrinsic/intrinsic), spirituality (Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale), quality of life (FACT-G), and depression (Hospital Anxiety and Depression Scale).

Results

There was a small relationship between intrinsic religiosity and depression (r = −0.23, p < 0.05) but a strong association between spirituality and depression (r = −0.58, p < 0.01). Using a mediation model, the meaning/peace subscale of the spirituality measure mediated the relationship between intrinsic religiosity and depression. This model controlled for age, marital status, stage of disease, time since diagnosis, hormone therapy, quality of life, and anxiety.

Conclusions

When examining religiosity and spirituality, the main component that may help reduce depression is a sense of meaning and peace. These results highlight the potential importance of developing a patient’s sense of meaning through activities/interventions (not exclusive to religious involvement) to achieve this goal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. National Mental Health Strategy (Australia), Australia. Department of Health and Aged Care. Mental Health and Special Programs Branch. National action plan for depression : under the National Mental Health Plan: 1998–2003. Canberra: Mental Health and Special Programs Branch, Commonwealth Departmrnt of Health and Aged Care, 2001.

  2. Task Force on DSM-IV, American Psychiatric Association, American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV. 4th ed. Washington: American Psychiatric Association; 1994.

    Google Scholar 

  3. Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004; 32: 57-71.

    Article  PubMed  Google Scholar 

  4. Wulsin LR, Vaillant GE, Wells VE. A systematic review of the mortality of depression. Psychosom Med. 1999; 61: 6-17.

    CAS  PubMed  Google Scholar 

  5. van't Spijker A, Trijsburg RW, Duivenvoorden HJ. Psychological sequelae of cancer diagnosis: a meta-analytical review of 58 studies after 1980. Psychosom Med. 1997; 59: 280-293.

    Google Scholar 

  6. American Cancer Society. www.cancer.org.

  7. Roth AJ, Kornblith AB, Batel-Copel L, et al. Rapid screening for psychologic distress in men with prostate carcinoma: A pilot study. Cancer. 1998; 82: 1904-1908.

    Article  CAS  PubMed  Google Scholar 

  8. Muldoon M, King N. Spirituality, health care, and bioethics. J Relig Health. 1995; 34: 329-349.

    Article  PubMed  Google Scholar 

  9. Vaughan R, Wittine B, Walsh R. Transpersonal psychology and the religious person. In: Shafranske EP, ed. Religion and the Clinical Practice of Psychology. Washington: American Psychological Association; 1988: 483-509.

    Google Scholar 

  10. Ellerhorst-Ryan JM. Measuring aspects of spirituality. In: Frank-Stromborg M, ed. Instruments for Clinical Nursing Research Norwalk. CT: Appleton and Lange; 1988: 141-149.

    Google Scholar 

  11. Brady MJ, Peterman AH, Fitchett G, Mo M, Cella D. A case for including spirituality in quality of life measurement in oncology. Psychooncology. 1999; 8: 417-428.

    Article  CAS  PubMed  Google Scholar 

  12. Miller WR, Thoresen CE. Spirituality, religion, and health. An emerging research field. Am Psychol. 2003; 58: 24-35.

    Article  PubMed  Google Scholar 

  13. Emblen JD. Religion and spirituality defined according to current use in nursing literature. J Prof Nurs. 1992; 8: 41-47.

    Article  CAS  PubMed  Google Scholar 

  14. Elkins DN, Hedstrom LJ, Hughes LL, Leaf JA, et al. Toward a humanistic–phenomenological spirituality: Definition, description, and measurement. J Humanist Psychol. 1988; 28: 5-18.

    Article  Google Scholar 

  15. Donahue MJ. Intrinsic and extrinsic religiousness: Review and meta-analysis. J Pers Soc Psychol. 1985; 48: 400-419.

    Article  Google Scholar 

  16. McClain CS, Rosenfeld B, Breitbart W. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet. 2003; 361: 1603-1607.

    Article  PubMed  Google Scholar 

  17. Nelson CJ, Rosenfeld B, Breitbart W, Galietta M. Spirituality, religion, and depression in the terminally ill. Psychosomatics. 2002; 43: 213-220.

    Article  PubMed  Google Scholar 

  18. Klap R, Unroe KT, Unutzer J. Caring for mental illness in the United States: A focus on older adults. Am J Geriatr Psychiatry. 2003; 11: 517-524.

    PubMed  Google Scholar 

  19. Smith TB, McCullough ME, Poll J. Religiousness and depression: Evidence for a main effect and the moderating influence of stressful life events. Psychol Bull. 2003; 129: 614-636.

    Article  PubMed  Google Scholar 

  20. McCullough ME, Larson DB. Religion and depression: A review of the literature. Twin Res. 1999; 2: 126-136.

    Article  CAS  PubMed  Google Scholar 

  21. Koenig HG, Hays JC, George LK, et al. Modeling the cross-sectional relationships between religion, physical health, social support, and depressive symptoms. Am J Geriatr Psychiatry. 1997; 5: 131-144.

    CAS  PubMed  Google Scholar 

  22. Levin JS, Markides KS, Ray LA. Religious attendance and psychological well-being in Mexican Americans: A panel analysis of three-generations data. Gerontologist. 1996; 36: 454-463.

    CAS  PubMed  Google Scholar 

  23. Bienenfeld D, Koenig HG, Larson DB, Sherrill KA. Psychosocial predictors of mental health in a population of elderly women. Test of an explanatory model. Am J Geriatr Psychiatry. 1997; 5: 43-53.

    CAS  PubMed  Google Scholar 

  24. Pressman P, Lyons JS, Larson DB, Strain JJ. Religious belief, depression, and ambulation status in elderly women with broken hips. Am J Psychiatry. 1990; 147: 758-760.

    CAS  PubMed  Google Scholar 

  25. Brown DR, Gary LE. Religious involvement and health status among African-American males. J Natl Med Assoc. 1994; 86: 825-831.

    CAS  PubMed  Google Scholar 

  26. Ferraro K. Firm Believers? Religion, body weight, and well-being. Rev Religion Res. 1998; 39: 224-244.

    Article  Google Scholar 

  27. Musick MA, Koenig HG, Hays JC, Cohen HJ. Religious activity and depression among community-dwelling elderly persons with cancer: The moderating effect of race. J Gerontol B Psychol Sci Soc Sci. 1998; 53: S218-227.

    CAS  PubMed  Google Scholar 

  28. Strawbridge WJ, Shema SJ, Cohen RD, Roberts RE, Kaplan GA. Religiosity buffers effects of some stressors on depression but exacerbates others. J Gerontol B Psychol Sci Soc Sci. 1998; 53: S118-126.

    CAS  PubMed  Google Scholar 

  29. Koenig HG. Religion and depression in older medical inpatients. Am J Geriatr Psychiatry. 2007; 15: 282-291.

    Article  PubMed  Google Scholar 

  30. Koenig HG, George LK, Titus P. Religion, spirituality, and health in medically ill hospitalized older patients. J Am Geriatr Soc. 2004; 52: 554-562.

    Article  PubMed  Google Scholar 

  31. Koenig HG, George LK, Titus P, Meador KG. Religion, spirituality, and acute care hospitalization and long-term care use by older patients. Arch Intern Med. 2004; 164: 1579-1585.

    Article  PubMed  Google Scholar 

  32. King DA, Lyness JM, Duberstein PR, et al. Religious involvement and depressive symptoms in primary care elders. Psychol Med. 2007; 37: 1807-1815.

    Article  CAS  PubMed  Google Scholar 

  33. Moreira-Almeida A, Neto FL, Koenig HG. Religiousness and mental health: A review. Rev Bras Psiquiatr. 2006; 28: 242-250.

    PubMed  Google Scholar 

  34. Allport GW, Ross JM. Personal religious orientation and prejudice. J Pers Soc Psychol. 1967; 5: 432-443.

    Article  CAS  PubMed  Google Scholar 

  35. Kendler KS, Liu XQ, Gardner CO, et al. Dimensions of religiosity and their relationship to lifetime psychiatric and substance use disorders. Am J Psychiatry. 2003; 160: 496-503.

    Article  PubMed  Google Scholar 

  36. Krause N. Measuring religiosity in later life. Res Aging. 1993; 15: 170-197.

    Article  Google Scholar 

  37. Fehring RJ, Miller JF, Shaw C. Spiritual well-being, religiosity, hope, depression, and other mood states in elderly people coping with cancer. Oncol Nurs Forum. 1997; 24: 663-671.

    CAS  PubMed  Google Scholar 

  38. Ginia V, Shaw DG. Religion, intrinsic–extrinsic orientation, and depression. Rev Relig Res. 1991; 32: 276-283.

    Google Scholar 

  39. Nelson PB. Ethnic differences in intrinsic/extrinsic religious orientation and depression in the elderly. Arch Psychiatr Nurs. 1989; 3: 199-204.

    CAS  PubMed  Google Scholar 

  40. Watson PJ, Hood RW, Foster SG, et al. Sin, depression, and narcissism. Rev Relig Res. 1988; 29: 295-305.

    Article  Google Scholar 

  41. Yi MS, Mrus JM, Wade TJ, et al. Religion, spirituality, and depressive symptoms in patients with HIV/AIDS. J Gen Intern Med. 2006; 21(Suppl 5): S21-27.

    Article  PubMed  Google Scholar 

  42. McCoubrie RC, Davies AN. Is there a correlation between spirituality and anxiety and depression in patients with advanced cancer? Support Care Cancer. 2006; 14: 379-385.

    Article  PubMed  Google Scholar 

  43. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23: 56-62.

    Article  CAS  PubMed  Google Scholar 

  44. Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.

    Google Scholar 

  45. Brewer EDC. Life stages and spiritual well-being. In: Moberg DO, ed. Spiritual Well-Being, Sociological Perspectives. Washington: University of America Press; 1979: 99-111.

    Google Scholar 

  46. Fife BL. The conceptualization of meaning in illness. Soc Sci Med. 1994; 38: 309-316.

    Article  CAS  PubMed  Google Scholar 

  47. Hilton BA. The relationship of uncertainty, control, commitment, and threat of recurrence to coping strategies used by women diagnosed with breast cancer. J Behav Med. 1989; 12: 39-54.

    Article  CAS  PubMed  Google Scholar 

  48. Maltby J. The internal structure of a derived, revised, and amended measure of the Religious Orientation Scale: The ‘Age-Universal’ I-E Scale-12. Soc Behav Pers. 1999; 27: 407-412.

    Article  Google Scholar 

  49. Trimble DR. The religious orientation scale: Review and meta-analysis of social desirablity effects. Educ Psychol Meas. 1997; 57: 970-986.

    Article  Google Scholar 

  50. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67: 361-370.

    Article  CAS  PubMed  Google Scholar 

  51. Spinhoven P, Ormel J, Sloekers PP, et al. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997; 27: 363-370.

    Article  CAS  PubMed  Google Scholar 

  52. Savard J, Laberge B, Gauthier JG, Ivers H, Bergeron MG. Evaluating anxiety and depression in HIV-infected patients. J Pers Assess. 1998; 71: 349-367.

    Article  CAS  PubMed  Google Scholar 

  53. Cella DDF, Tulsky DDS, Gray GG, et al. The Functional Assessment of Cancer Therapy Scale: Development and validation of the general measure. J Clin Oncol. 1993; 11: 570.

    CAS  PubMed  Google Scholar 

  54. Esper PP, Mo FF, Chodak GG, et al. Measuring quality of life in men with prostate cancer using the functional assessment of cancer therapy-prostate instrument. Urology. 1997; 50: 920.

    Article  CAS  PubMed  Google Scholar 

  55. Nelson CJ, Holland J, Roth AJ. Assessing depression in geriatric cancer patients: Do we have appropriate measures? Abstract to be Presented at the Annual Conference of the American Psych-Oncology Society. Irvine, CA, 2008.

  56. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Erlbaum; 1988.

    Google Scholar 

  57. Roth A, Nelson CJ, Rosenfeld B, et al. Assessing anxiety in men with prostate cancer: further data on the reliability and validity of the Memorial Anxiety Scale for Prostate Cancer (MAX-PC). Psychosomatics. 2006; 47: 340-347.

    Article  PubMed  Google Scholar 

  58. Nelson CJ, Holland J, Roth AJ. Does growing older help cancer patients cope? Understanding how age impacts distress, anxiety, and depression in prostate cancer patients. Paper will be presented at the Annual Meeting of the American Psycho-Oncology Society. Irvine, CA, 2008.

  59. Nelson CJ, Bhaskaran V, Breitbart W, BR, AR. Distress in African-American men with prostate cancer. [Abstract] Annual Meeting of the Society of Behavioral Medicine. 2007.

  60. Pirl WF, Mello J. Psychological complications of prostate cancer. Oncology (Williston Park). 2002; 16: 1448-1453. discussion 1453–1444, 1457–1448, 1467.

    Google Scholar 

  61. Pirl WF, Siegel GI, Goode MJ, Smith MR. Depression in men receiving androgen deprivation therapy for prostate cancer: A pilot study. Psychooncology. 2002; 11: 518-523.

    Article  PubMed  Google Scholar 

  62. Babyak MA. What you see may not be what you get: A brief, nontechnical introduction to overfitting in regression-type models. Psychosom Med. 2004; 66: 411-421.

    Article  PubMed  Google Scholar 

  63. Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986; 51: 1173-1182.

    Article  CAS  PubMed  Google Scholar 

  64. Bjorck JP, Thurman JW. Negative life events, patterns of positive and negative religious coping, and psychological functioning. J Sci Study Relig. 2007; 46: 159-167.

    Article  Google Scholar 

  65. Hart SL, Vella L, Mohr DC. Relationships among depressive symptoms, benefit-finding, optimism, and positive affect in multiple sclerosis patients after psychotherapy for depression. Health Psychol. 2008; 27: 230-238.

    Article  PubMed  Google Scholar 

  66. McGregor BA, Antoni MH, Boyers A, et al. Cognitive-behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. J Psychosom Res. 2004; 56: 1-8.

    Article  PubMed  Google Scholar 

  67. Carver CS, Antoni MH. Finding benefit in breast cancer during the year after diagnosis predicts better adjustment 5 to 8 years after diagnosis. Health Psychol. 2004; 23: 595-598.

    Article  PubMed  Google Scholar 

  68. Penedo FJ, Antoni MH, Schneiderman N. Cognitive-behavioral stress management for prostate cancer recovery: Facilitator guide. Oxford: Oxford University Press; 2008.

    Google Scholar 

  69. Kinney CK, Rodgers DM, Nash KA, Bray CO. Holistic healing for women with breast cancer through a mind, body, and spirit self-empowerment program. J Holist Nurs. 2003; 21: 260-279.

    Article  PubMed  Google Scholar 

  70. Freeman L, Cohen L, Stewart M, et al. Imagery intervention for recovering breast cancer patients: Clinical trial of safety and efficacy. J Soc Integr Oncol. 2008; 6: 67-75.

    PubMed  Google Scholar 

  71. Breitbart W, Gibson C, Poppito SR, Berg A. Psychotherapeutic interventions at the end of life: A focus on meaning and spirituality. Can J Psychiatry. 2004; 49: 366-372.

    PubMed  Google Scholar 

  72. Chochinov HM, Hack T, Hassard T, et al. Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol. 2005; 23: 5520-5525.

    Article  PubMed  Google Scholar 

  73. Kissane DW, Clarke DM, Street AF. Demoralization syndrome—A relevant psychiatric diagnosis for palliative care. J Palliat Care. 2001; 17: 12-21.

    CAS  PubMed  Google Scholar 

  74. Taylor RJ, Chatters LM, Jackson JS. Religious and spiritual involvement among older African Americans, Caribbean blacks, and non-Hispanic whites: Findings from the national survey of american life. J Gerontol B Psychol Sci Soc Sci. 2007; 62: S238-250.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christian Nelson Ph.D..

About this article

Cite this article

Nelson, C., Jacobson, C.M., Weinberger, M.I. et al. The Role of Spirituality in the Relationship Between Religiosity and Depression in Prostate Cancer Patients. ann. behav. med. 38, 105–114 (2009). https://doi.org/10.1007/s12160-009-9139-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-009-9139-y

Keywords

Navigation