Psychological Medicine

Original Articles

Religious service attendance and spiritual well-being are differentially associated with risk of major depression

J. Maselkoa1 c1, S. E. Gilmana2 and S. Bukaa3

a1 Department of Public Health, Temple University, Philadelphia, PA, USA

a2 Departments of Epidemiology and Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA

a3 Department of Community Health, Brown University, Providence, RI, USA


Background The complex relationships between religiosity, spirituality and the risk of DSM-IV depression are not well understood.

Method We investigated the independent influence of religious service attendance and two dimensions of spiritual well-being (religious and existential) on the lifetime risk of major depression. Data came from the New England Family Study (NEFS) cohort (n=918, mean age=39 years). Depression according to DSM-IV criteria was ascertained using structured diagnostic interviews. Odds ratios (ORs) for the associations between high, medium and low tertiles of spiritual well-being and for religious service attendance and the lifetime risk of depression were estimated using multiple logistic regression.

Results Religious service attendance was associated with 30% lower odds of depression. In addition, individuals in the top tertile of existential well-being had a 70% lower odds of depression compared to individuals in the bottom tertile. Contrary to our original hypotheses, however, higher levels of religious well-being were associated with 1.5 times higher odds of depression.

Conclusions Religious and existential well-being may be differentially associated with likelihood of depression. Given the complex interactions between religiosity and spirituality dimensions in relation to risk of major depression, the reliance on a single domain measure of religiosity or spirituality (e.g. religious service attendance) in research or clinical settings is discouraged.

(Received April 02 2008)

(Revised August 01 2008)

(Accepted August 16 2008)

(Online publication October 06 2008)


c1 Address for correspondence: J. Maselko, Sc.D., Temple University, 1700 N. Broad St, Rm 304, Philadelphia, PA 19130, USA. (Email: