Promoting mental health and reducing mental illness have been identified as global health priorities (World Health Organization, 2002). Mental illness can be understood as significant changes in cognition, emotion regulation, and behavior, which may be caused by underlying psychological, biological, and developmental dysfunctions (American Psychiatric Association, 2013). Mental illness also involves clinically significant disturbances in social, occupational, and daily life activities (American Psychiatric Association, 2013).
It is estimated that one in five Canadians are affected by mental illness every year (Smetanin et al., Reference Smetanin, Stiff, Briante, Adair, Ahmad and Khan2011). The most prevalent forms of mental illness in Canada are depression and anxiety (Public Health Agency of Canada, 2015). Mental illness is a major cause of disability and, in Canada, it has been estimated that mental illness accounts for more than $6 billion in lost productivity per year (Smetanin et al., Reference Smetanin, Stiff, Briante, Adair, Ahmad and Khan2011). Cross-sectional data suggest that the prevalence of depression is higher among women and young adults and that the prevalence of depression progressively decreases across the adult lifespan (Pearson, Janz, & Ali, Reference Pearson, Janz and Ali2015; Statistics Canada, 2016).
Conversely, mental health is defined as a positive state of well-being, where one is able to cope with everyday life stressors and make contributions to society (World Health Organization, 2014). Positive mental health is characterized by a cluster of positive indicators related to the subjective experience of an individual, such as their lived experiences of positive feelings (i.e., emotional well-being) and positive functioning (i.e., psychological well-being and social well-being; Keyes, Reference Keyes, Gentile and Miller2009). Positive mental health consists of individuals’ subjective appraisal of their own happiness, life satisfaction, and psychological/social well-being (Keyes, Reference Keyes1998). The absence of positive mental health has been linked to poor academic performance, suicidal behaviour, chronic disease, and mortality (Keyes, Reference Keyes2007; Reference Keyes, Eisenberg, Perry, Dube, Kroenke and Dhingra2012; Keyes & Simoes, Reference Keyes and Simoes2012).
The distinction between mental health and mental illness is captured within the dual-continua model of mental health and mental illness (Keyes, Reference Keyes, Gentile and Miller2009). The dual-continua model suggests that a person may experience high positive mental health while experiencing no signs of mental illness, whereas others may experience poor mental health while concurrently living with symptoms of mental illness (Keyes, Reference Keyes, Gentile and Miller2009). On the one hand, flourishing individuals are those with positive mental health who exhibit high levels of well-being, positive emotions (e.g., happiness, sense of life satisfaction, peacefulness), and positive functioning (e.g., trusting relationships, satisfaction with oneself, feeling of belonging to a community, feeling that their life is useful towards the community) (Keyes, Reference Keyes2002; Reference Keyes, Gentile and Miller2009). On the other hand, languishing individuals (i.e., individuals without mental health) experience feelings of emptiness, stagnation, and exhibit lower life satisfaction and well-being (Keyes, Reference Keyes2002; Keyes, Reference Keyes2005).
In a cross-sectional study of Dutch participants whose ages ranged across the adult lifespan, Westerhof and Keyes (Reference Westerhof and Keyes2010) examined whether mental illness and mental health varied simultaneously by age group. Consistent with existing literature (e.g., Beekman, Copeland, & Prince, Reference Beekman, Copeland and Prince1999), older adults were found to exhibit fewer symptoms of mental illness, except for participants in the oldest-old age category, who, the authors suggest, likely experience differences in life circumstances. In terms of positive mental health, the authors concluded that older participants report a similar degree of mental health as do younger participants. These findings align with more recent data showing consistent rates of flourishing across the lifespan (Gilmour, Reference Gilmour2014).
Within the last 20 years, there has been a growing interest in the factors that promote mental health and, in particular, the relationship between religion and/or spirituality and mental health (Dein, Reference Dein2014). Although religion and spirituality are often studied together (Koenig, Reference Koenig2009), it should be noted that there are differences between these constructs. There is no single accepted definition of spirituality; however, Pargament, Mahoney, Exline, Jones, and Shafranske (Reference Pargament, Mahoney, Exline, Jones, Shafranske, Pargament, Exline and Jones2013) suggest that spirituality may involve the ongoing search for the sacred and a belief in a higher power. Koenig, King, and Carson (Reference Koenig, King and Carson2012) describe spirituality as a connection with the transcendent, which may be found within an organized religion, meditation, or the self. Spirituality may also involve the search for and connection with the transcendent, a higher power, and/or supernatural and mystical forces (Koenig et al., Reference Koenig, King and Carson2012). It is often considered an individualistic concept, oriented towards the self, as it is less observable than religion (Koenig, McCullough, & Larson, Reference Koenig, McCullough and Larson2001). Religion, on the other hand, is often understood as formal practices involving agreed-upon behaviours (Koenig et al., Reference Koenig, McCullough and Larson2001) that take place within the context of institutions and traditions (Pargament et al., Reference Pargament, Mahoney, Exline, Jones, Shafranske, Pargament, Exline and Jones2013). Pargament et al. (Reference Pargament, Mahoney, Exline, Jones, Shafranske, Pargament, Exline and Jones2013) argue that the primary goal of religion is to facilitate spirituality. Given these differences and similarities, it is challenging to tease apart the independent effects of these two constructs within research (Baiden & Fuller-Thomson, Reference Baiden and Fuller-Thomson2016; Fuller-Thomson, Agbeyaka, LaFond, & Bern-Klug, Reference Fuller-Thomson, Agbeyaka, LaFond and Bern-Klug2016; Gilmour, Reference Gilmour2014; Koenig, Reference Koenig2009); as such, we refer to religion/spirituality (R/S) throughout this study.
R/S has been shown to be positively associated with well-being, hope, optimism, and increased life satisfaction (Lifshitz, Nimrod, & Bachner, Reference Lifshitz, Nimrod and Bachner2018). Based on Canadian data, Dilmaghani (Reference Dilmaghani2018) also noted that religiosity brought forward a sense of belonging, means for self-improvement, and a sense of direction and meaning in life. Further, R/S is associated with increased social and emotional support, health behaviours, positive cognitive appraisals, a sense of meaning, and higher self-esteem (Dein, Reference Dein2006; Reference Dein2018). Although R/S is associated with mental health outcomes throughout the lifespan (Bailly et al., Reference Bailly, Martinent, Ferrand, Agli, Giraudeau and Gana2018), the literature specifically highlights its positive role in the lives of older adults (Damianakis & Marziali, Reference Damianakis and Marziali2012; Wink, Dillon, & Larsen, Reference Wink, Dillon and Larsen2005). In particular, evidence suggests that aging is a determinant of mental health (Fuller-Thomson et al., Reference Fuller-Thomson, Agbeyaka, LaFond and Bern-Klug2016) and that the importance of R/S increases over the lifespan (Koenig & Cohen, Reference Koenig and Cohen2006 ; Wink & Dillon, Reference Wink and Dillon2002). Older adults who report being religious and/or spiritual are more likely to report higher levels of well-being, meaningful experiences, and positive emotions; lower levels of anxiety; and greater vitality (Fry, Reference Fry2000; Lawler-Row & Elliott, Reference Lawler-Row and Elliott2009; Lee, Reference Lee2011; Sadler & Biggs, Reference Sadler and Biggs2007).
Some authors suggest that one may turn towards R/S in efforts to cope with life stressors, which tend to occur in older age, including the onset of chronic disease, loss of family and friends, and existential and financial issues (Koenig, Reference Koenig2006). Others suggest that as individuals age, their personal resources decline and they look to external coping resources (Baltes & Smith, Reference Baltes, Smith, Bengtson and Schaie1999). Some lines of evidence point to greater involvement in and importance of religion and spirituality among older people (Argue, Johnson, & White, Reference Argue, Johnson and White1999; Wink & Dillon, Reference Wink, Dillon, Plante and Sherman2001). In line with these findings, Tornstam’s (Reference Tornstam1989) theory of gerotranscendence posits that aging is a developmental stage that involves a natural shift from a rational and materialistic world-view to one that is focused on the cosmic and transcendental, and often accompanied by increased satisfaction (Wadensten, Reference Wadensten2007).
Consistent with the theory of gerotranscendence and with definitions of R/S, it may be that R/S becomes increasingly important with aging. Indeed, a clinically informed qualitative study of recovery from depression among older adults showed that participants who were admitted to a psychiatric hospital discovered new world views and ways of living, which often involved acceptance of the self and a heightened sense of spirituality (Tanaka, Reference Tanaka2018). Agli, Bailly, and Ferrand (Reference Agli, Bailly and Ferrand2015) noted that faith, religious and spiritual practices, and maintaining social functioning are associated with a slowing of cognitive decline and increasing quality of life among persons with dementia (Agli et al., Reference Agli, Bailly and Ferrand2015). In older samples, R/S has been shown to be positively linked to quality of life (Sawatzy, Ratner, & Chiu, Reference Sawatzy, Ratner and Chiu2005), well-being, acceptance of death, and confidence, as well as satisfaction with the aging process (Shaw, Gullifer, & Wood, Reference Shaw, Gullifer and Wood2016).
In his theoretical model outlining the relationship between R/S and health, Krause (Reference Krause, Silverstein and Bengston2018) suggests that R/S can impact health and well-being by: buffering stress through, for example, religious coping responses; facilitating the provision and receipt of emotional support; and supporting growth through adversity. He highlights the importance of R/S in helping to maintain or rediscover a sense of meaning when faced with adversity. Others have recognized R/S as a potential source of strength for individuals coping with stressors (Bozard & Sanders, Reference Bozard and Sanders2011). When considering the evidence highlighting the growing importance of R/S across the lifespan (e.g., Koenig & Cohen, Reference Koenig and Cohen2006; Wink & Dillon, Reference Wink and Dillon2002), it is unsurprising that researchers have found a stronger effect of R/S on health among older age groups (Krause, Pargament, Hill, Wong, & Ironson, Reference Krause, Pargament, Hill, Wong and Ironson2017). Considering the operationalization of positive mental health (described previously) as well as the already established importance of meaning to mental health, specifically among older adult populations (Fry, Reference Fry2000; Lawler-Row & Elliott, Reference Lawler-Row and Elliott2009; Lee, Reference Lee2011; Sadler & Biggs, Reference Sadler and Biggs2007), it follows that R/S would be associated with both mental health and mental illness outcomes, an effect that would be strongest among older adults.
Recently, important Canadian work has further elucidated the relationship between R/S and mental health in large population health samples. For example, Dilmaghani (Reference Dilmaghani2018) examined participants’ (n = 20,868) responses to the question “In general, how important are religious or spiritual beliefs in your daily life?” in relation to three single-item outcomes capturing mental well-being. The author categorized participants as either highly religious, of average religiosity, or secularized. In comparison with participants categorized as of average religiosity, highly religious participants and secularized participants showed favourable mental health outcomes. Subsequent work by Speed, Barry, and Cragun (Reference Speed, Barry and Cragun2020) examined the relationship between R/S and mental health outcomes, including positive mental health and psychological distress, in the 2012 Canadian Community Health Survey–Mental Health (CCHS-MH) Component. The results of their analysis indicated that R/S was associated with better mental health outcomes and that social support attenuated those observed relationships.
Evidence suggests that Canada is becoming an increasingly secular society (Pew Research Center, 2013). Given the links between R/S and health, it was of interest to examine the role of R/S on mental health and mental illness across the lifespan within an increasingly secular context. Although important Canadian work has highlighted the positive effect of R/S on health outcomes (e.g., Speed & Fowler, Reference Speed and Fowler2021), age has not been explored as a potential effect modifier of the relationships between R/S and mental health and illness. Examining age as a moderator would lend support to the theory of gerotranscendence and augment our knowledge of R/S within the context of an aging population. Therefore, the purpose of this study was to examine the relationship among R/S, mental health, and mental illness in a sample of Canadian adults. Consistent with the aforementioned literature, it was hypothesized that individuals who report drawing strength from R/S beliefs would be more likely to have positive mental health and less likely to report psychological distress. We also hypothesized that the mental health promoting effect of R/S would depend on age, and be most pronounced among older adults (i.e., those 65 years and older).
Method
Study Sample
Data for this study were drawn from the 2012 CCHS-MH Component, a national cross-sectional population health study conducted by Statistics Canada. The CCHS-MH samples persons living within the ten provinces of Canada over a 12-month period. Various groups were excluded from the sample, such as indigenous persons living on reserves, full-time members of the armed forces, and individuals residing in institutional settings (e.g., prisons, long-term care), groups that altogether represent approximately 3 per cent of the entire Canadian population (Statistics Canada, 2018). The full sampling strategy is described elsewhere (Statistics Canada, 2018). The 2012 CCHS-MH respondent level response rate was 86.3 per cent (Statistics Canada, 2018). The sample for this study included respondents 25 years of age and older (n = 25,113), and after removal of missing data through listwise deletion, the analytic samples were 20,019 and 18,200 for the analyses involving psychological distress and positive mental health, respectively.
The CCHS utilizes a complex sampling strategy with unequal selection probability, which permits computation of estimates that are representative of the Canadian population, increasing the generalizability of study results when survey weights which consider the CCHS-MH design effect are used. Survey weights were applied to all analyses presented here. We computed normalized survey weights (mean = 1.00), as has been done by others who have used the CCHS-MH (Fuller-Thomson et al., Reference Fuller-Thomson, Agbeyaka, LaFond and Bern-Klug2016). Normalized survey weights help to protect against artificial increases in the likelihood of observing statistically significant results (Fuller-Thomson et al., Reference Fuller-Thomson, Agbeyaka, LaFond and Bern-Klug2016). The normalized weights were then divided by the square root of the CCHS-MH design effect to obtain the analytic weights, accounting for clustering of the complex survey design. This two-step approach has been used by others who have used the CCHS (Orr, Potter, Ma, & Colman, Reference Orr, Potter, Ma and Colman2017). Data were accessed using the CCHS Public Use Microdata file (PUMF), a publicly available data set. Trained interviewers collected participant information through the use of computer assisted personal interviewing (CAPI) and computer assisted telephone interviewing (CATI). This analysis of the data was approved by the Saint Paul University research ethics board (REB).
Covariates
To control for variables already known to be related to mental health and mental illness (Gilmour, Reference Gilmour2014; Hooten, Reference Hooten2016), and to account for age-related differences in socio-demographic variables, several covariates were entered into the model.
Age
Participants were asked to report their chronological age in years. To maintain participants’ anonymity, the PUMF contains age groups based on 5-year increments (e.g., 25–29). Given our interest in R/S and mental health across the adult lifespan, participants were grouped into three categories to approximate stages of adult development characterized elsewhere in the literature (Wink & Dillon, Reference Wink and Dillon2002): young/middle adulthood (i.e., 25–44 years), late middle adulthood (i.e., 45–64 years), and older adulthood (i.e., ≥ 65 years). Similar age categories have been used in previous research using the CCHS-MH (Gilmour, Reference Gilmour2014). Note that the results presented here remain unchanged when age is treated as a continuous variable within the models.
Sex
In the survey, participants were asked to indicate their sex as male or female.
Other covariates
Household income was measured by asking participants to report their total household income from all sources. There were five income category brackets: “< 20k”, “20–39k”, “40–59k”, “60–79k”, and “> 80k”. Participants’ education (i.e., “< secondary school graduation”, “secondary school graduation”, “some post-secondary”, “post-secondary graduation”) and marital/relationship status (“single/separated/divorced”, “widowed”, and “married and common law”) were collected. Participants’ race/ethnicity was described as white or non-white. Chronic pain was assessed using a single item which asked participants about the extent that pain prevented daily activities (e.g., “no pain or discomfort”, “pain prevents no or few activities”, and “pain prevents some or most activities”). Close relationships were captured by asking participants whether their relationships provided” them with a sense of emotional security and well-being; responses ranged from, “strongly agree” to “strongly disagree”. For the purpose of this study, “strongly agree” and “agree” were collapsed to indicate presence of close relationships. Lifetime prevalence of selected mental health/substance abuse disorders was assessed by asking whether participants had ever been diagnosed with the selected conditions (e.g., major depressive episode, alcohol dependence) by a health professional (yes/no).
Predictor: Strength from R/S
In order to measure strength from R/S, participants were asked one question: “To what extent do your religious or spiritual beliefs give you the strength to face everyday difficulties?”. Response options were as follows: “a lot”, “some”, “a little”, or “not at all” (Fuller-Thomson et al., Reference Fuller-Thomson, Agbeyaka, LaFond and Bern-Klug2016).
Outcomes
Positive mental health
In order to measure positive mental health, participants completed the Mental Health Continuum-Short Form (MHC-SF) (Lamers, Glas, Westerhif, & Bohlmeijer, Reference Lamers, Glas, Westerhif and Bohlmeijer2012). The MHC-SF consists of 14 items: 3 of the items measure emotional well-being, and 11 of the items measure positive functioning. The MHC-SF has been shown to have high internal validity, high internal reliability (α = 0.89), and moderate test–retest reliability (Lamers, Westerhof, Bohlmeijer, ten Klooster, & Keyes, Reference Lamers, Westerhof, Bohlmeijer, ten Klooster and Keyes2011). An example of a question administered to measure emotional well-being is “In the past month, how often did you feel happy?” An example of a question used to measure positive functioning is “In the past month, how often did you feel good at managing the responsibilities of your daily life?” For each item, response options ranged from, “0-never”, “1-once or twice”, “2-about once a week”, “3-about 2 or 3 times a week”, “4-almost every day”, and “5-every day”. The continuous score for positive mental health was used herein and ranged from 0 to 70, with higher scores reflective of greater positive mental health.
Psychological distress
Kessler’s Psychological Distress Scale (K6) is a six-item measure used to assess symptoms related to major depressive disorder (MDD) and generalized anxiety disorder (GAD) based on the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised (DSM-III-R) (Kessler et al., Reference Kessler, Andrews, Colpe, Hiripi, Mroczek and Normand2002). The K6 has shown construct validity across genders (Drapeau et al., Reference Drapeau, Beaulieu-Prevost, Marchand, Boyer, Preville and Kairouz2010) and has been validated in a large community sample (Khan, Chien, & Burton, Reference Khan, Chien and Burton2014). Scale items include: “During the past month, how much did these feelings usually interfere with your life or activities” and “During the past month, that is, from now to yesterday, about how often did you feel sad or depressed?” The response options ranged from: “4-all of the time”, “3-most of the time”, “2-some of the time”, “1-a little of the time”, to “0-none of the time”. Items were summed in order to obtain a total score which ranged from 0 to 24, where higher scores represented a higher degree of psychological distress. Considering the clinical relevance of the K6 and previous validation work (Prochaska, Sung, Max, Shi, & Ong, Reference Prochaska, Sung, Max, Shi and Ong2012), scores < 5 represented low distress, scores from 5 to 13 represented moderate distress, and scores >13 represented severe distress. The moderate and severe categories were merged in order to indicate presence of elevated psychological distress.
Statistical Analysis
Differences in socio-demographic characteristics by respondent age were explored using χ2 tests of independence for categorical measures and analysis of variance (ANOVA) for the continuous measures. When treating positive mental health as the outcome, we employed a general linear model (i.e., proc glm), weighted to account for the complex survey methodology, to run a multivariable linear regression model. Given the clinical relevance related to elevated psychological distress, we used weighted logistic regression techniques treating moderate/severe distress as the outcome. In order to examine whether the effect of R/S on positive mental health and psychological distress depended on age (i.e., presence of effect modification), an R/S by age interaction was entered into the multivariable regression models. In the case of a statistically significant interaction term, results were probed using the slice statement to obtain least squares means which were then visualized (Tobias & Cai, Reference Tobias and Cai2010). A (-2) log likelihood test of the change in model fit was used to assess improvement in the logistic regression model with the inclusion of an R/S by age interaction term. Where there was no evidence of effect modification, non-significant interaction terms were removed, and the main effect models are presented. Data were analysed using SAS 9.4 (SAS Institute, Inc., Cary, NC).
Results
Sample Characteristics
As shown in Table 1, 51.3 per cent of respondents were women and 48.7 per cent were men. Seventy-eight percent of participants were white and 21.7 per cent were visible minorities. The majority of respondents resided in higher earning households (≥ $80,000), had obtained a post-secondary education, were single/separated/divorced, reported having close relationships with others, were free of chronic pain, did not have a lifetime mental health diagnosis, and self-reported receiving “a lot” of strength from R/S in order to face everyday difficulties. There were statistically significant differences among age groups across all socio-demographic characteristics. In particular, older participants had lower household incomes, lower levels of education, and were more likely to be white. Older adults in the analytic sample were more likely to be in pain. Older adults were more likely to report drawing strength from R/S and less likely to report a lifetime mental health diagnosis than younger groups. Twenty-two percent of respondents reported moderate-high psychological distress.
Table 1. Respondent characteristics by age group (n=20,019): Canadian Community Health Survey – Mental Health (2012)
Note. Table presents results (p-value) of χ2 tests of independence for categorical variables or analysis of variance (ANOVA) for continuous measures. The measure of positive mental health ranged from 0 to 70, with higher scores reflective of higher positive mental health. Survey weights were applied.
Positive Mental Health
The overall test of the positive mental health model was statistically significant (F[26, 18,173] = 159.05, p < 0.001), with the model explaining 18.54 per cent of the variance in positive mental health. The increase in variance accounted for by the inclusion of the interaction term was 0.10 per cent. There was evidence of a statistically significant R/S by age interaction on positive mental health (F = 3.76, p = 0.001). The η2p for the main effects of R/S, age, and the R/S by age interaction are as follows: η2p = 0.028, η2p = 0.002, and η2p = 0.001, respectively. The regression parameter estimates are presented in Table 2, while the estimates of the simple effects (least squares means) are visualized in Figure 1. Figure 1 shows that greater reliance on drawing strength from R/S in order to face everyday difficulties was associated with higher positive mental health among all three age groups, but that the relationship between R/S and positive mental health was most pronounced for respondents 65 years of age and older. Table 3 shows the differences among age groups in estimates of simple effects for positive mental health at levels of R/S; these results show that respondents in the middle (45–64 years) and lowest (25–44 years) age groups have comparable levels of positive mental health at the highest level of R/S (p = 0.761, see Table 3).
Figure 1. Simple effects of the interaction between religion/spirituality (R/S) and age group on positive mental health
Table 2. Multiple linear regression results for the relationship between religion/spirituality and positive mental health
Note. Total scores for continuous positive mental health (outcome) ranged from 0 to 70 with higher scores reflective of greater positive mental health. Referent group denoted by dashes (--). aThe test of the religion/spirituality by age interaction was statistically significant at p < 0.05 (test of the interaction: F = 3.76, p = 0.001).
Table 3. Differences between age groups in estimates of simple effects (weighted least squares means [LSM]) for positive mental health at levels of religion/spirituality
Psychological Distress
When psychological distress was treated as the outcome, there was a statistically non-significant R/S by age interaction (p > 0.05 for all interaction terms); therefore, the R/S by age interaction was removed from the parsimony model. With four levels of R/S and three levels of age, there were six corresponding interaction terms: “a little” and 45–64 years: p = 0.495; “a little” and ≥ 65 years: p = 0.134; “some” and 45–64 years: p = 0.442; “some” and ≥ 65 years: p = 0.971; “a lot” and 45–64 years: p = 0.921; and “a lot” and ≥ 65 years”: p = 0.739. In the main effect model (see Table 4) adjusted for covariates, there were no associations between R/S and psychological distress (p > 0.05). There was an inverse relationship between age and psychological distress; older respondents were at reduced odds of reporting psychological distress (45–64 years: p < 0.001; ≥ 65+ years: p < .001), compared with respondents in the youngest age category (25–44 years). The overall model reached statistical significance (χ2[20] = 2231.06, p < 0.001).
Table 4. Logistic regression results for the relationship between religion/spirituality and psychological distress
Note. CI = confidence interval; OR = odds ratio.
Discussion
In this study, we examined whether R/S was associated with positive mental health and psychological distress. In addition, we examined whether the effects of R/S depend on age. The analyses yielded several noteworthy findings.
The analyses showed a significant R/S by age group interaction suggesting that the effects of R/S on positive mental health were dependent on age; the positive relationship between R/S and positive mental health was greatest among participants 65 years of age and older. These results are consistent with findings from pre-existing literature which support the promoting factor of R/S across the adult lifespan (Noronha, Reference Noronha2015; Worthington, Reference Worthington1989). In addition, evidence shows that older adults in particular may draw on R/S (Agli et al., Reference Agli, Bailly and Ferrand2015; Colishaw, Niele, Teshuva, Browning, & Kendig, Reference Colishaw, Niele, Teshuva, Browning and Kendig2013). These findings support theories of aging which point to the importance of R/S during this stage of life (e.g., Erikson, Reference Erikson1982; Erikson, Erikson, & Kivnick, Reference Erikson, Erikson and Kivnick1989; Tornstam, Reference Tornstam1989). Indeed, the literature notes that older adults who report drawing on R/S demonstrate greater resilience when faced with challenges (Reis & Menezes, Reference Reis and Menezes2017). R/S has also been shown to act as a buffer against depression and loneliness in older adults with mobility loss (Han & Richardson, Reference Han and Richardson2010).
In terms of psychological distress, we did not observe an interaction between R/S and age, nor did we observe a main effect of R/S. Although some literature points towards a benefit of drawing on R/S in treatment of mental illness (Corrigan, McCorkle, Schell, & Kidder, Reference Corrigan, McCorkle, Schell and Kidder2003; Harris et al., Reference Harris, Nienow, Choi, Engdahl, Nguyen and Thuras2015), other work suggests that R/S is not necessarily beneficial for persons living with mental illness. For example, when examining the effects of R/S on patients living with schizophrenia, Mohr, Brandt, Borras, Gillieron, and Huguelet (Reference Mohr, Brandt, Borras, Gillieron and Huguelet2006) reported that in some cases R/S was seen as being a detriment to treatment, as some patients may experience increased psychotic symptoms, induced spiritual despair, increased suicide attempts, and substance abuse. Our sample was a non-clinical community sample in whom the prevalence of clinically significant psychological distress was lower than in clinical samples. The nature of our sample precluded examination of whether individuals with especially elevated distress have a unique relationship with R/S.
Although we did not observe a statistically significant effect of R/S in the model examining psychological distress, other variables did significantly contribute. It is of note that history of mental illness, absence of close relationship, presence of pain, and low income were among the statistically significant variables in the model. As others have noted, the relationship between R/S and health outcomes is largely dependent upon the variables under investigation (Krause, Reference Krause, Silverstein and Bengston2018). The pattern of findings we observed highlights the importance of using the dual-continua model of mental health and mental illness in order to understand their respective determinants.
This study adds to the growing body of literature of R/S, aging, and mental health and has numerous strengths. The data were drawn from a large, representative sample of community-dwelling adult Canadians, with a high response rate. In addition, we accounted for numerous potential confounding variables (e.g., marital status, income, mental health disorders, and substance use) which could bias the associations of interest. Our focus on the dual-continua of mental health and the use of validated outcome measures offers a more complete account of the relationship between R/S and psychological outcomes.
R/S was quantified by asking participants the extent to which they draw strength from R/S to face everyday difficulties. This item aligns with Krause’s (Reference Krause, Silverstein and Bengston2018) view that R/S can promote health by acting as a resource that facilitates coping in the face of adversity. As others have pointed out, aging is associated with an increased risk of adversity related to, for example, health and mobility challenges (Baltes & Smith, Reference Baltes, Smith, Bengtson and Schaie1999), necessitating coping skills in order to maintain positive mental health. It follows that we observed the strongest relationship between R/S and positive mental health among the older adults in the sample.
On the other hand, several authors have pointed out that R/S represents multifaceted and distinct phenomena (e.g., Corrigan et al., Reference Corrigan, McCorkle, Schell and Kidder2003; Hill et al., Reference Hill, Pargament, Hood, McCullough, Swyers and Larson2000); as such, the relationships between spirituality and mental health as well as between religion and mental health may be differential. Because of our inability to tease apart the construct of R/S, we are unable to determine whether participants based their responses on religion, spirituality, or a combination of the two. Given that spirituality can describe an individualistic experience, researchers note that one may identify with being spiritual without adhering to a religion (Hill et al., Reference Hill, Pargament, Hood, McCullough, Swyers and Larson2000). Future research should measure the two constructs separately, so that potential differences between the effects of spirituality versus those of religion on health across the lifespan can be disentangled.
Demographic data suggest that Canada is becoming increasingly secular (Pew Research Centre, 2013). It is possible that the age-dependent effect of R/S is reflective of cohort differences between young, mid-aged, and older adults, rather than of changes related to human development and the aging process. Given that this study is cross-sectional in nature, we cannot assess the temporality of variables nor do these data permit causal inferences. Future research should examine whether the effects observed here are replicable within longitudinal data sets and within other cultural contexts. Finally, the existing literature showing a relationship between R/S and health emphasizes the role of immigration status, ethnicity, and R/S identity, variables that were not captured here (Dilmaghani, Reference Dilmaghani2018; Speed & Fowler, Reference Speed and Fowler2021)
The proportion of the Canadian population 65 years of age and older has been increasing over the last 40 years and is projected to continue to increase as members of the baby boomer generation all reach 65 years of age (year 2031) (Statistics Canada, 2012). Data from the 2016 Census of the Canadian population show that there were 5,900,000 persons 65 years of age and older residing in Canada; for the first time in Canadian history, the number of individuals 65 years of age and older outnumber individuals 14 years of age or less (Statistics Canada, 2017). As members of this population continue to age, the likelihood of experiencing age-associated stressors (e.g., illness, loss of spouse) increases, and R/S may be an important means of coping with such stressors. Longitudinal work is needed to better understand the potential positive effects of R/S across the lifespan. Our study highlights the importance of R/S among all Canadian adults and the fact that R/S is particularly salient in older adults’ lives. This study also underlines the importance of quantifying mental health and mental illness separately when examining their determinants. Promoting positive mental health throughout the adult lifespan may involve attending to and supporting spiritual beliefs, traditions, and practices.
