Journal of Religion and Health

https://doi.org/10.1007/s10943-019-00958-9

ORIGINAL PAPER

Religion/Spirituality and Gender‑Differentiated Trajectories

of Depressive Symptoms Age 13–34

Blake Victor Kent1

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Abstract
Studies examining religion/spirituality (R/S) and depressive symptoms report diver-
gent findings, often depending on the types of variables considered. This study
assessed whether subjective and experiential R/S variables were associated with
increased depressive symptom burden from adolescence to young adulthood. Vari-
ations by gender were also assessed. Using group-based trajectory modeling with
a cohort-sequential design, four distinct symptom trajectories were identified for
women and five for men. 27.4% of women and 10.2% of men were classified on
peak trajectory groups. Religious attendance was protective for men and women.
Prayer was protective for women but linked to risk for men. Born-again and life-
changing spiritual experiences, along with belief in supernatural leading and
angelic protection, were broadly associated with increased classification on elevated
symptom trajectories. In one exception, belief in supernatural leading was associ-
ated among some men with decreased risk of depressive symptoms during adoles-
cence. Researchers must take a variety of R/S variables into account when assessing
depressive symptoms, not simply religious attendance, prayer frequency, or affilia-
tion as is commonly practiced. Religion and spirituality are multidimensional and in
some cases may operate differently for men than women vis-à-vis mental well-being.

Keywords Life course · Adolescence · Emerging adulthood · Depressive symptoms ·

Group-based modeling · Religion · Spirituality

Introduction

Links between religion/spirituality (R/S) and depression have received increas-

ing attention over time, both in the young adult and broader populations (Oman
and Lukoff 2018). Past research on R/S and depression has addressed a variety of

* Blake Victor Kent

bvkent@mgh.harvard.edu
1
Center on Genomics, Vulnerable Populations, and Health Disparities, Harvard Medical School/
Massachusetts General Hospital, 50 Staniford St. Suite 802, Boston, MA 02114, USA

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 Journal of Religion and Health

populations, from adolescents to the elderly and has often utilized religious attend-
ance as the primary R/S variable of interest (Koenig et al. 2012). Much of the
research has indicated religious attendance is commonly associated with positive
mental well-being (Koenig et al. 2012; Rew and Wong 2006). However, emerging
research examining R/S from a more experiential or subjective perspective suggests
these types of R/S may be associated with decreased mental well-being (Ellison and
Lee 2010; Hayward et al. 2012). Scholars conducting this work emphasize that R/S
must be examined from many angles since it is multifaceted and not easily reduced
to a single dimension.
At the same time, research on the US population, including adolescents and
young adults, reveals marked gender differences in self-reports and diagnosis of
depression (Garber et al. 2002; Kessler et al. 2005), with women more likely to
experience internalizing disorders such as depression and anxiety (Kessler 2003).
Reviews of the literature make clear that both gender and religion play a significant
role, each accounting for approximately 10% of the variance in depressive symptom-
atology (Koenig et al. 2012; Nolen-Hoeksema et al. 1999). However, little is known
of whether religion matters differently for men than women or whether the relation-
ship shifts with varying measures of religion and spirituality.
The current study sheds light on the relationship between subjective R/S and
depressive symptoms, important among the young adult sample utilized here for
several reasons. First, depressive symptoms often first develop during adolescence
(Fergusson and Woodward 2002). Second, adolescents and young adults commonly
turn to religious sources of authority to make sense of their lives and answer difficult
questions (Smith and Snell 2009). And third, religion can be a source of insight and
growth, but also of pain and frustration (Ellison and Lee 2010). Better understand-
ing the association between R/S and depressive symptoms can help parents, edu-
cators, religious professionals, and counselors better care for young and emerging
adults.1
The study’s primary aim was first to examine links between depressive symp-
toms and an array of R/S predictors, including those more experiential or subjec-
tive in nature; second, to examine these relationships separately in young men and
women; and third, to examine these differences using group-based trajectory mod-
els (GBTM) in a large, national sample. Group-based studies extract unique latent
class trajectories within a sample and offer unique insights into the etiologies of
depressive symptom burden (Musliner et al. 2016). These types of studies have been
underutilized in the examination of R/S and depressive symptoms.

1
While this inquiry utilizes a younger sample, it is broadly interested in subjective religiosity and
depressive symptoms. Thus, studies from a variety of sample populations inform the paper.

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Journal of Religion and Health

Background Literature

Religion/Spirituality and Depressive Symptoms

The relationship between religion and depressive symptoms has received increas-
ing attention. In the second edition of the Handbook of Religion and Health,
Koenig et al. (2012) summarized 339 studies published between 2000 and 2010
examining R/S and depression, up from 104 pre-2000 studies identified for the
first edition. The majority of these found a salutary relationship between R/S and
depression. For example, Strawbridge et al. (2001) found that participants who
were depressed at baseline and attended religious services weekly or more were
2.3 times more likely to recover during the 29-year follow-up period. Similarly,
Van Voorhees et al. (2008) found in a 12-month follow-up of adolescents that
regular prayer and attending youth religious services predicted decreased odds of
new-onset depressive disorders.
In these analyses, the predominant measurement of R/S was a form of religious
attendance or participation. Religious participation was similarly prevalent in a
review of depression among adolescents by Rew and Wong (2006), and many
scholars agree this beneficial relationship likely operates through the mechanisms
of social support and buffering (e.g., George et al. 2002). While involvement in
US civic institutions is generally on the decline (Putnam 2000), those who regu-
larly attend religious services can gain access to a network of coreligionists who
are able and willing to provide emotional, spiritual, and material support (Krause
2002). Adolescents in particular may seek out support in religious institutions
when facing difficult questions (Marin 2016).
Not all studies report a beneficial association, however. Overall, 6 percent
of cross-sectional studies and 11 percent of prospective studies located for the
Handbook found that R/S was associated with higher levels of depression. These
studies often incorporated R/S measures beyond attendance, and what researchers
are now beginning to recognize is that R/S is multifaceted and its relationship to
depression changes depending on context and measurement. For example, several
studies examined measures of R/S that moved into the perceptual realm, includ-
ing perceived religiousness (Baetz et al. 2004) and salience of spiritual values
(Baetz et al. 2006). Hayward et al. (2012) examined not just attendance, but also
religious media use, private religious practice, religious salience, group affilia-
tion, and report of born-again or other life-changing religious experiences. They
found (in an already depressed elderly sample) that attendance and a born-again
experience were linked to lower depression, while prayer was linked to higher.
A good deal of further research has convincingly linked perceptions of attach-
ment to God to poor mental health when the perceived attachment relationship is
insecure (Bradshaw et al. 2010; Bradshaw and Kent 2018; Ellison et al. 2014).
This underscores the possibility that subjective R/S measures may be valuable
for understanding depression, especially in cases where the individual’s experi-
ence of God does not line up with personal and collective religious norms and
expectations. It is increasingly clear that R/S is multidimensional, associating

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with depression via multiple pathways not limited to social support/buffering

in religious participation. Subjective, experiential, and perceptual measures are
understudied and present a fresh opportunity to examine religion and spirituality.

Religion/Spirituality, Gender, and Depression

While studies in R/S and depression typically control for gender, only a handful specifi-
cally examine gender differences. Of those that do, a common theme emerges which
is consistent with literature on the religious gender gap (Schnabel 2015); that is, men
and women may have different depressed mood outcomes vis-à-vis religion and spir-
ituality. However, the direction of the relationship is not consistent in these studies. For
example, in one case men who did not attend religious services or who stopped attend-
ing were at lower risk of lifetime major depression, whereas no relationship was found
among women (Maselko and Buka 2008). In another case, men obtained greater ben-
efit from religious involvement than women (McFarland 2010). In a sample of Muslim
Palestinian students, religious involvement was inversely related to depression for all
respondents, but more so for women than men (Barber 2001). And in a longitudinal
study of six European countries, women appeared more likely to cope with depressive
symptoms through religious participation than men (Angst et al. 2002). The inconsist-
encies of these findings represent a knowledge gap on this topic; in some cases, women
benefit more, while in others, men benefit.
One possible source of insight on this conundrum is the religious attachment lit-
erature. Researchers here suggest that social, congregational, and divine attachments
are consequential for well-being, and that gender differences in attachment may play a
role (Freeze and DiTommaso 2015; Kent and Henderson 2017; Kent and Pieper 2019;
Kirkpatrick 2005). For example, women might benefit from religious sources of sup-
port because they more effectively utilize the relational nature of these sources (rela-
tionships in the congregation, relationship with God, etc.) for comfort and support.
Men might benefit, however, since they tend to have less support than women across
their range of relationships (Vaux 1985) and religious support represents, for many, a
significant gain.
The general approach that informed this analysis was that many women and men in
the US are differentially socialized in normed religious contexts to engage in social and
divine relationships. The resulting gendered religious experiences are consequential to
mental health. Further, meeting or violating theological norms regarding relationship
with God also provide a mechanism for mental health outcomes in certain branches of
US religion.

Study Aims

In summary, the aims of this study were threefold. The first was to examine an
array of R/S measures, including subjective perceptions of divine involvement in
the respondent’s life. New developments in the sociology and psychology of reli-
gion demonstrate that perceptions of God’s engagement in the world and in the

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respondent’s life are highly consequential (Ellison et al. 2014; Granqvist and Kirk-
patrick 2013), and even religious devotional acts like prayer can be attended by
negative self-appraisal (Bradshaw and Kent 2018). Importantly, these consequences
may be higher in Pentecostal and charismatic religious groups where “talking to”
and “hearing from” God is normative (Koenig et al. 2012; Luhrmann 2012).
Thus, in addition to religious attendance, prayer, and salience, this study exam-
ined experiential/subjective religious reports (i.e., having a born-again experi-
ence, having a spiritual experience that changed the respondent’s life, believing
God leads the respondent in daily decisions, and belief that angels watch and pro-
tect the respondent). Experiential spirituality may increase as a coping response to
depressed mood, or it may generate depressed mood under specific circumstances,
but whatever the causal order, this type of spirituality was expected to associate with
increased depressive symptom burden.
The second and third aims were intertwined. They were to examine gender dif-
ferences, and do so using disaggregated group-based trajectory models. Gender-
specific depressive symptom trajectories provided an opportunity to identify distinct
symptom etiologies for male and female respondents. In their review of the group-
based depression literature, Musliner et al. (2016) reported a higher proportion of
women fell into burdened trajectories of depressive symptoms. Few of these stud-
ies, however, disaggregated the sample by gender, and no group-based studies have
examined religion and spirituality.
Thus, this study not only examined subjective and experiential measures of R/S
but also provided a group-based assessment of more commonly used indicators such
as religious attendance. The study disaggregated men and women to identify the
number of functional trajectories for each gender, the shape of these trajectories, and
any patterns of similarity or difference between men and women.

Data and Methods

Sample

Data for this analysis were drawn from Waves 1, 3, and 4 of the National Longitudi-
nal Study of Adolescent to Adult Health (Add Health), a nationally representative,
probability-based survey of American adolescents who were in grades 7–12 during
the 1994–1995 school year. A total of 12,118 participants formed a “core” nation-
ally representative sample, with additional respondents comprising strategic over-
samples of minority racial/ethnic groups, totaling 20,745. Subsequent waves were
collected in 1995–1996 (W2), 2001–2002 (W3), and 2007–2008 (W4). Waves 1, 3,
and 4 were used here to construct age-based depressive symptom trajectories of all
respondents with complete data for depressive symptom measurements, a require-
ment of group-based trajectory modeling. Add Health is administered with a core
study/supplementary module strategy and therefore did not assess depressive symp-
toms in every respondent across all waves, but rather administered select variables
to its participants while maintaining representativeness among racial/ethnic groups.
For this reason, 7725 participants did not qualify for this analysis. Wave 2 was not

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used since its chronological proximity to Wave 1 unnecessarily replicated the age-
based structure (see Analytic Strategy) and resulted in the loss of additional cases
that could be preserved with Waves 1 and 3, and 4. 61 respondents were removed
from the sample who were 12 at the time of Wave 1 or 35 at the time of Wave 4 since
they were too few in number to be considered representative of their age groups. A
further 711 were dropped due to missing sampling weights, resulting in a final sam-
ple of 12,248 (for more information on why some cases do not have weights see
http://www.cpc.unc.edu/proje​cts/addhe​alth/faqs/about​data/). Multiple imputations
were not used to recover missing covariate data since GBTM assumes a hypothesis
of multiple subgroups, which is at odds with multiple imputations’ assumption of a
single population (Colder et al. 2001).

Compliance with Ethical Standards

Subjects provided written informed consent in accordance with the University of

North Carolina Institutional Review Board guidelines and the study complied with
professional standards of ethical conduct. The author has no conflicts of interest to
report, and while Add Health is funded by grant number P01-HD31921 from the
NICHD, no direct support was received by the author for this work.

Outcome Variable

Participants responded to nine items on the CES-D scale common to Waves 1, 3, and
4. The CES-D assessed how often respondents experienced depressed affect in the
past week (“bothered by things,” “could not shake the blues,” “felt depressed,” etc.).
Responses ranged from 0 (never or rarely) to 3 (most or all of the time). The items
showed good internal consistency across the three waves with an alpha of .80.

Predictor Variables

The primary variables of interest included a battery of religion/spirituality items.

Four of them were unique to the W3 questionnaire. These included having a born-
again experience (1 = yes), a spiritual experience that changed your life (1 = yes),
belief that coincidences are not really coincidences; I am being “led” spiritually
(1 = strongly agree and agree), and belief that angels are present to help or watch
over me (1 = strongly agree and agree). Three items were available in both the W1
and W3 questionnaires. These assessed religious service attendance (0 = never to
6 = several times a week), prayer frequency (0 = never to 7 = more than once a day),
and salience of religious faith (0 = not important to 3 = more important than any-
thing else).2 W1 items controlled for those religion/spirituality measures unique to
W3 (see Wickrama and Wickrama 2010).

2
W1 provided fewer response options than W3 for attendance and prayer. Recoding to match did not
substantively alter results, so W3 scaling was retained.

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Journal of Religion and Health

Covariates

Female was based on biological sex at Wave 4. Race/ethnicity was coded as a

dummy system with white, black, Hispanic, Asian, Native American, and other
(W1). Religious tradition was coded as a dummy system of Evangelical, Mainline
Protestant, Black Protestant, Catholic, Jewish, other, and none (W1) (Steensland
et al. 2000). The additional covariates correlated with levels of religious participa-
tion or depressive symptoms and thus served as important controls: mother’s and
father’s education (W1, bachelor’s degree or more = 1), self-rated health (W1, and
W3, ranged 1–5 with 1 = poor and 5 = excellent), marital status (W3, married = 1),
income (W3, in dollars), employment status (W3, employed = 1), education (W3,
in years), and children in home (W3, children = 1)3 (Edgell 2013; McFarland et al.
2011; Mirowsky and Ross 2003; Naicker et al. 2013; Uecker 2014).

Analytic Strategy

This study utilized a semi-parametric group-based modeling approach (Nagin 2005).

Prior to estimation of the trajectory groups, data were converted to an age-based
cohort-sequential design (rather than wave-based) since age is a better metric than
wave for assessing symptom trajectories (Adkins et al. 2009; Costello et al. 2008;
Miyazaki and Raudenbush 2000; Wickrama and Wickrama 2010). Age categories
for this design were constructed in 2-year increments beginning at age 13–14 and
ending at 33–34. If too few respondents were in an age category to ensure repre-
sentativeness (typically at the upper and lower bounds of each wave), they were
dropped. Bayesian information criterion (BIC) and maximum likelihood estimates
(MLE) were used as recommended (Nagin 2005; Xie et al. 2006) to evaluate: (a) the
model fit; (b) the optimal number of trajectory groups; and (c) the functional form of
each trajectory (e.g., intercept-only, linear, quadratic, cubic). Models were assessed
with the full sample as well as separate samples by gender. Separating the sample
provided marginally better model fit, as well as a unique number of trajectories and
functional shapes indicating etiological distinctions between men and women. A
four-group quadratic solution for women maximized BIC and returned significant
MLE, so it was selected. Average posterior probability (APP) for each group was
stable low = .94, early high = .65, mid-high = .78, and late high = .78. For males, a
five-group model maximized BIC and returned appropriate MLE. All trajectories
fit a quadratic form with the exception of the elevated group, which took a linear
form, APP for stable low = .91, elevated = .66, early high = .89, mid-high = .84, and
late high = .92. Multinomial logistic regression was used to examine the association
among covariates, key independent variables, and trajectory group classes. Thus,
the trajectory group classes formed the outcome (rather than a score or indicator of

3
Parental education was only asked at W1. W3 variables were assessed at that time since that survey
cycle included the R/S variables of interest.

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 Journal of Religion and Health

2
Depressive Symptoms
1.5
1
.5
0

15 20 25 30 35
Age

1 Stable low (72.6%) 4 Mid high (5.5%)

3 Early high (12.4%) 2 Late high (9.4%)

Fig. 1  Unconditional female model of predicted depressive symptom trajectories (Waves 1, 3, and 4 Add
Health, N = 6658)

depressive symptoms). R/S items were assessed both independently and together.
Though correlation coefficients among R/S items (not reported) were low to mod-
erate, minor differences in coefficients in the full analytic models did not alter the
overall story. Therefore, R/S items were modeled together.

Results

Trajectory Plots

Figure 1 displays the unconditional model of female respondents, which illustrates

“raw” depressive symptom trajectories that do not include risk covariates in the tra-
jectory plots (Clark and Muthén n.d.). Four distinct trajectories emerged, with 72.6%
of respondents classified in the stable low symptom group. The remaining 27.4%
were classified in one of three groups following unique developmental trajectories
that ranged from moderately elevated to high levels of symptom burden.
Figure 2 displays the unconditional model of male respondents. The primary
change in these two figures was the emergence of a stable, moderately elevated
symptom burden group. 64.1% of males were classified in the stable low group, with
25.7% classified on the stable, moderately elevated group. Whereas 27.4% of women
were classified on a trajectory reaching high levels of symptomatology, only 10.2%
of men were classified on such a trajectory. The plots suggest that while relatively
few men experience high levels of depressive symptoms, variation exists in lower
levels (i.e., the addition of the stable moderate group). The plots affirm research sug-
gesting that women tend to be more prone to internalizing disorders than men (Kes-
sler 2003).

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Journal of Religion and Health

2.5
Depressive Symptoms
2
1.5
1
.5
0

15 20 25 30 35
Age

1 Stable low (64.1%) 2 Elevated (25.7%)

4 Early high (3.4%) 3 Late high (3.9%)
5 Mid high (2.9%)

Fig. 2  Unconditional male model of predicted depressive symptom trajectories (Waves 1, 3, and 4 Add
Health, N = 5590)

Group Means

Table 1 reports Wave 3 religion and spirituality means for each trajectory group by
gender. For females, increased levels of religious attendance were reported on the
stable low trajectory group. These respondents also reported higher levels of prayer
and religious salience compared to the mid- and late high groups. Stable low women
reported slightly lower levels of agreement that angels watch over them in compari-
son with the early-high group.
Among males, the stable low group reported higher levels of service attendance
than those classified as elevated, with no difference in prayer or religious salience.
The stable low group also reported lower levels of spiritual experience, feelings of
being led by the spirit, and belief that angels watch over them.4 Overall, females
reported higher levels of religious belief and behavior than men in all categories
except born-again experience.

Multinomial Regression

Odds ratios in Table 2 estimated the probability that increased religion/spirituality

was associated with membership on a burdened trajectory group. In females, reli-
gious service attendance was associated with decreased odds of classification on all
burdened symptom trajectories, as was prayer frequency when comparing the late
high to stable low groups. No significant relationship emerged in religious salience
or born-again experience. Having had a life-changing spiritual experience indicated
an increase in classification on the mid- and late high groups, as well as marginally

4
Small N’s in the other three groups give them comparatively low statistical power. Contrast between
the high burden groups and the stable low group might still represent substantive differences.

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 Table 1  Group means of Add Health Wave 3 religion/spirituality items by gender
Trajectory group N Service attendance Prayer frequency Religious salience Born-again Spiritual experience Led by spirit Angels protect me
experience

13
Range 0–6 0–7 0–3 0–1 0–1 0–1 0–1
Female
Stable low (s) 4923 2.39eml 4.22ml 1.57ml .13 .29 .48 .69e
sm
Early high (e) 857 2.10 4.12 1.53 .15 .31 .52 .74s
se s s
Mid-high (m) 350 1.69 3.78 1.45 .11 .34 .49 .69
Late high (l) 528 1.90s 3.84s 1.46s .13 .30 .50 .71
Total 6658 2.28# 4.16# 1.55# .13 .29# .49# .70#
ANOVA F 23.83*** 6.75*** 5.06** 1.04 1.82 1.81 3.13*
Male
Stable low (s) 3661 1.94v 3.24 1.39 .12 .24vm .40m .51m
s sm
Elevated (v) 1498 1.77 3.11 1.36 .13 .28 .44 .55
Early high (e) 147 1.69 3.39 1.37 .09 .30 .43 .58
Mid-high (m) 143 1.73 3.44 1.40 .17 .39sv .54sl .63e
Late high (l) 141 1.66 3.60 1.37 .11 .28 .37m .57
# # # #
Total 5590 1.87 3.22 1.38 .12 .26 .41# .53#
ANOVA F 2.97* 1.87 .22 1.46 5.58*** 3.87** 4.12**

*p < .05; **p < .01; ***p < .001

s
Contrasts with stable low at p < .05
v
Contrasts with elevated at p < .05
e
Contrasts with early high at p < .05
m
Contrasts with mid-high at p < .05
l
Contrasts with late high at p < .05
#
Average for all females differs significantly from all males at p < .05
Journal of Religion and Health
 Table 2  Multinomial regression of depressive symptom trajectory group on Wave 3 religion/spirituality (Add Health, female N = 6658, male N = 5590)
Trajectory group Service attendance Prayer frequency Religious sali- Born-again expe- Spiritual expe- Led by spirit Angels protect me
Journal of Religion and Health

ence rience rience

Female
Stable low (ref)
Early high .93* .99 .94 1.18 1.22† 1.42** 1.17
†
Mid-high .84*** .97 .99 .68 1.46* 1.37 .91
Late high .88** .91** .99 1.01 1.31* 1.06 1.35*
Male
Stable low (ref)
Elevated .95† .99 .89† 1.13 1.30** 1.12 1.19†
Early high .99 1.17*** .78 .61 2.04** .48*** 2.05**
Mid-high .96 1.07 .70* 1.81* 1.91** 2.02** .94
Late high .84* 1.13** .72* 1.87* 1.25 1.04 1.02

Race/ethnicity, parent education, religious attendance, prayer, and religious tradition were controlled at Wave 1. Self-rated health was controlled at Waves 1 and 3. Marital
status, income, employment, education, and children were controlled at Wave 3
†
p < .1; *p < .05; **p < .01; ***p < .001. Males and females regressed separately, R/S variables regressed together. Coefficients are odds ratios

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 Journal of Religion and Health

increased odds for classification on the early high group. Belief in being led spiritu-
ally was linked with higher odds of classification on the early high trajectory, as well
as higher marginal odds on the mid-high group. Belief in angelic care was related to
classification on the late high group.
In male respondents, religious service attendance was associated with decreased
odds of membership on the elevated (marginal) and late high groups. Private prayer
was associated with increased odds of classification on the early and late trajecto-
ries, and religious salience was associated with lower odds of membership on the
elevated (marginal association), mid-, and late high groups. Males who reported
having a born-again experience had higher odds of placement on the mid- and
late high groups, while those reporting a spiritual experience that changed their
life had increased odds of classification on the elevated, early high, and mid-high
groups. Belief in being led spiritually was associated with higher odds of placement
on the mid-high group and decreased odds on the early high group. Belief in angelic
care was linked with increased odds of classification on the elevated (marginal asso-
ciation) and early high groups.

Discussion

This study examined an array of objective and subjective religion/spirituality vari-

ables and depressive symptom trajectories in the US adolescent and young adult
population. The study examined more traditional, objective variables and emerging,
subjective variables net of one another, doing so over a lengthy period of develop-
ment in both men and women.
Findings on a standard objective measure—religious attendance—bore out prior
research. Increased attendance was associated with lower odds of classification on
elevated depressive symptom trajectories. This held true for all comparison groups
among women and some groups among men. Where coefficients reached signifi-
cance for men and women the reductions in odds were similar. The remainder of R/S
items revealed several potential differences by gender, either in the direction of the
R/S–depression relationship or in the magnitude of classification odds.

Prayer

The direction of the relationship here moved in opposite directions for men and
women. For women, prayer was either nonsignificant or associated with decreased
symptom burden, but for men it was associated with increased burden. Why? On
average, US women report higher levels of engagement in religion and spiritual-
ity (Schnabel 2015) and also report higher levels of intimacy with God (Kent and
Pieper 2019). For those experiencing deeper intimacy with God (more often women
than men), prayer has been associated with positive well-being, while the oppo-
site has been shown for those feeling distant from God (Bradshaw and Kent 2018).
Given this, it is possible to speculate that two dynamics may be at play: frequency of

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Journal of Religion and Health

engagement and quality of engagement. Motivation differs for the first, while experi-
ence differs for the second.
Frequency of engagement suggests that women pray more often, and do so
because of an increased value on relational components of faith (Buchko 2004). For
men, prayer is less frequent because “men’s relationships are framed by different
motivations, objectives, and benefits, which results in unique implications for their
spirituality” (Bryant 2007, p. 836). The theoretical implication is that women are
more likely to pray regardless of their depressive state since relationally connecting
through prayer is a higher priority. Men, on the other hand, are more likely to pray in
response to a specific need, such as feelings of depression.
Quality of engagement would amplify these dynamics. Because women experi-
ence greater intimacy and security with God (Kent and Pieper 2019), it is likely that
when they pray the experience is more efficacious than it is for men, who report
lower levels of intimacy. For men, the act of prayer may be less effective or even
introduce further distress since prayer to a distant or critical God is attended by its
own set of risks, including fear of rejection and judgment (Kirkpatrick 2005). These
gendered dynamics assume average differences between men and women, and it is
insightful to note that accounting for intimate relationship with God can minimize or
nullify gender differences (Kent and Pieper 2019).

Religious Salience

In these data, no significant relationship emerged between religious salience and

depressive symptoms for women, but for men salience was linked with lower odds
of membership on several burdened trajectories. One possible explanation for this is
that more variation exists among men on this measure than women. In other words,
the data may capture real differences between men who prioritize their faith over
against those who do not. American men participate less than women in religious
practices (Schnabel 2015), and the gap expands through adolescence and emerging
adulthood (Dillon and Wink 2007). Thus, men who hold their faith in high regard
are likely to behave differently than those with marginal faith or no faith at all. Con-
sequently, they are more likely than their counterparts to pursue R/S practices and
commitments that are in turn linked to mental well-being.
The final four items—having a born-again or life-changing spiritual experience,
being led by the Spirit, and belief in angelic intervention—tap subjective and expe-
riential dimensions of R/S relevant to emerging adults as they navigate spiritual
beliefs and identity (Smith and Snell 2009). These variables collectively indicate a
disposition toward the supernatural which anticipates divine interaction and partici-
pation in one’s life. Interestingly, many of the tests performed here for both men and
women indicated these variables were associated with increased odds of member-
ship on burdened symptom trajectories. A straightforward explanation for this is that
people suffering from depression tend to seek out spiritual experiences and divine
affirmation as a means of symptom management (Baetz et al. 2006). This strategy
represents a resource mobilization approach in which spiritual resources are utilized
to deal with external stressors.

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But another explanation can be examined, one which assumes the reverse causal
direction. In short, what if the stressors are internal? What if the religious environ-
ment or beliefs themselves are the source of depressive symptoms? To pursue this
line of reasoning, let us consider the subjective/experiential variables as “windows”
into three facets of the religious faith experience: perception of oneself, perception
of God, and perception of others in the religious community. All of these may have
psychological consequences.
For example, evidence indicates that mental health and emotional well-being are
linked with consistency among one’s beliefs, actions, and relationships (Wink and
Scott 2005). Experience-driven religious environments (where divine interaction is
normalized) are liable to elevate the “risk” of an individual not living up to personal,
communal, or divine standards. In this case, uncertainty in the relationship with
God, fear over whether God is pleased, or failure to live up to spiritual expectations
might create a gap between idealized and actual spirituality (Hayward et al. 2012;
Henderson and Kent 2015; Murray and Ciarrocchi 2007).
US religious communities differ on their teaching about divine engagement, of
course, but a sizable swath, particularly within conservative Protestantism, promotes
highly interactive religious schemas. As Luhrmann (2012, p. 312) writes in her eth-
nography of conservative, charismatic congregations:
In experiential churches, the way God is imagined insists that a congregant pay
constant attention to her mind and world…she must scrutinize her thoughts
and mental images…looking for moments that might be God…such a theol-
ogy demands constant vigilance from those who follow it.
These environments are very likely to endorse strong views of the experiential
variables assessed here. Being “born-again” is unique in many ways to conservative
Christianity, and the types of “strict churches” (Iannaccone 1994) characterized by
born-again experiences also promote dependence on God in everyday life, exhorting
believers to seek God’s help in daily decision making (Luhrmann 2012). These prac-
tices demand high levels of attention, and people who are successful can be raised
up within the community as exemplars to be imitated (Hoffmann and Bartkowski
2008). It would not be surprising to find that believers (intentionally or not) compare
themselves to exemplars and to one another, effectively evaluating standing, con-
formity, and fit in the religious community. Such a practice may put some at risk of
distress when personal and communal standards are not achieved.
An additional issue applies particularly to men. In a religious culture that has
been increasingly “sentimentalized” during the twentieth century (Brenneman
2014), men may experience increased risk of depression since Western religious
norms have evolved to complement women more so than men (Podles 1999). Men
who choose to pursue spirituality in a “feminized” religious culture might not only
face scrutiny within the congregation but may also experience sanctioning—and
therefore distress—from actors and other forces external to the religious environ-
ment that see religious engagement (or accompanying behaviors) as out of step with
gender norms.
These data suggest one exception to this line of thinking, however. One expe-
riential R/S variable’s association with depression was unique among some men:

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Journal of Religion and Health

In the early-high trajectory group, day to day spiritual guidance exhibited a protec-
tive association during adolescence rather than serving as a risk factor. This seem-
ingly disparate finding may reflect a life-course pattern following norms in religious
training and upbringing. Despite overall gender differences in religious participa-
tion, participation is still common for young men during the years they are under
parental supervision. For many, adolescence is a period of time when learning to
seek and “hear” from God is an important part of spiritual formation. Indeed, many
church traditions representing millions view these activities as essential to become a
spiritually mature person (Luhrmann 2012; Smith and Snell 2009). In the context of
supportive family, friends, and fellow congregants, it is not difficult to imagine how
seeking spiritual guidance at this stage might be leveraged toward emotional health.
During a later stage in the life course, however (represented by the mid-high
group), the opposite relationship emerged. Expecting to hear from God in this group
was associated with increased risk of depression. This finding may correspond to
another life-course experience of some men, namely the experience of setbacks and
disappointments. While adolescence is often full of hope and optimism, it is pos-
sible that serious disappointments—whether they be vocational, relational, educa-
tional, spiritual, or of another kind altogether—begin to emerge in the mid-20’s. It is
possible that these disappointments are difficult for some to reconcile with the idea
of a God who is expected to “work all things together for your good,” as a popular
Bible verse suggests. Indeed, this mid-high group reported the highest score on each
of the four subjective R/S items (see Table 1), indicating that these men are more
oriented to divine involvement than their counterparts.
Perhaps, holding the highest expectations of God makes some men prone to the
greatest disappointments. Scholars have indeed linked disappointment with God and
spiritual struggles to depressive symptoms and psychological distress (Ellison and Lee
2010; Strelan et al. 2009), and at the popular level, books addressing disappointment
with God have sold copies in the millions (e.g., Yancey 1988, 2003). The Add Health
data do not support testing disappointment with God as a possible mechanism, but it
does present a plausible explanation which future work could meaningfully address.

Conclusion

Despite this study’s strengths, it is characterized by several limitations. First, while

self-report scales of depressive symptoms are considered reliable, the CES-D meas-
ure here did not constitute professional diagnosis of depression. Second, the study
relied on a large, national sample not developed by the authors, so direct measures
of disappointment with God or spiritual struggles were unavailable to examine as
intervening mechanisms. Third, it is possible the group-based modeling approach
over-extracts latent trajectory classes (Bauer and Curran 2003). However, BIC
penalizes too many parameters which helps prevent identifying excess classes.
Limitations notwithstanding, the study offered a number of important findings.
First, it documented gender differences in etiological trajectories of depressive
symptoms over a lengthy developmental course from adolescence to young adult-
hood. Second, it confirmed previous findings on the benefits of religious attendance

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 Journal of Religion and Health

by way of a group-based modeling strategy. Third, it added to the literature on sub-

jective and experiential religion and spirituality by showing that subjective forms of
R/S may be linked to higher depressive symptom burdens. Fourth, it indicated a pat-
tern in which experiential/subjective R/S may be more strongly linked to depressive
symptoms for men than women. And fifth, it indicated that one type of experiential
R/S—feeling spiritually led—may be protective for some men during adolescence.
These findings, though subject to replication and further testing, indicated that coun-
selors, psychologists, community leaders, and religious professionals should be cog-
nizant of young adults’ dispositions toward God and their spiritual experiences, as
they may be associated with differential mental health outcomes.

Acknowledgements This research uses data from Add Health, a program project directed by Kathleen
Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the
University of North Carolina at Chapel Hill. It was funded by Grant P01-HD31921 from the Eunice Ken-
nedy Shriver National Institute of Child Health and Human Development, with cooperative funding from
23 other federal agencies and foundations. No direct support was received from Grant P01-HD31921 for
this manuscript. The author thanks Matt Bradshaw, Matt Andersson, Lindsay Wilkinson, Chris Pieper,
and Wade Rowatt for helpful feedback.

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