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Religiosity and resilience in persons at high risk for major depression

  • S. Kasen (a1) (a2), P. Wickramaratne (a1) (a2) (a3) (a4), M. J. Gameroff (a1) (a2) (a3) and M. M. Weissman (a1) (a2) (a3)



Few studies have examined religiosity as a protective factor using a longitudinal design to predict resilience in persons at high risk for major depressive disorder (MDD).


High-risk offspring selected for having a depressed parent and control offspring of non-depressed parents were evaluated for psychiatric disorders in childhood/adolescence and at 10-year and 20-year follow-ups. Religious/spiritual importance, services attendance and negative life events (NLEs) were assessed at the 10-year follow-up. Models tested differences in relationships between religiosity/spirituality and subsequent disorders among offspring based on parent depression status, history of prior MDD and level of NLE exposure. Resilience was defined as lower odds for disorders with greater religiosity/spirituality in higher-risk versus lower-risk offspring.


Increased attendance was associated with significantly reduced odds for mood disorder (by 43%) and any psychiatric disorder (by 53%) in all offspring; however, odds were significantly lower in offspring of non-depressed parents than in offspring of depressed parents. In analyses confined to offspring of depressed parents, those with high and those with average/low NLE exposure were compared: increased attendance was associated with significantly reduced odds for MDD, mood disorder and any psychiatric disorder (by 76, 69 and 64% respectively) and increased importance was associated with significantly reduced odds for mood disorder (by 74%) only in offspring of depressed parents with high NLE exposure. Moreover, those associations differed significantly between offspring of depressed parents with high NLE exposure and offspring of depressed parents with average/low NLE exposure.


Greater religiosity may contribute to development of resilience in certain high-risk individuals.


Corresponding author

*Address for correspondence: S. Kasen, Ph.D., 100 Haven Avenue, Tower 3, Suite 31F, New York, NY 10032, USA. (Email:


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Aldwin, C (1994). Stress, Coping, and Development: An Integrative Perspective. Guilford Press: New York.
Beardslee, WR, Keller, MB, Klerman, GL (1985). Children of parents with affective disorder. International Journal of Family Psychiatry 6, 283299.
Brown, GW (1989). Life events and measurement. In Life Events and Illness (ed. Brown, G. W. and Harris, T. O.), pp. 345. Guilford Press: New York.
Daud, A, af Klinteberg, B, Rydelius, P-A (2008). Resilience and vulnerability among refugee children of traumatized and non-traumatized parents. Child and Adolescent Psychiatry and Mental Health 2:7. Published online: 28 March 2008. doi:10.1186/1753-2000-2-7.
D'Onofrio, BM, Eaves, LJ, Murrelle, L, Maes, HH, Spilka, B (1999). Understanding biological and social influences on religious affiliation, attitudes, and behaviors: a behavior genetic perspective. Journal of Personality 67, 953984.
Downey, G, Coyne, JC (1990). Children of depressed parents: an integrative review. Psychological Bulletin 108, 5076.
Ellison, CG, Flannelly, KJ (2009). Religious involvement and risk of major depression in a prospective nationwide study of African American adults. Journal of Nervous and Mental Disease 197, 568573.
Garmezy, N, Masten, AS, Tellegen, A (1984). The study of stress and competence in children: a building block for developmental psychopathology. Child Development 55, 107111.
George, LK, Larson, DB, Koenig, HG, McCullough, ME (2000). Spirituality and health: what we know, what we need to know. Journal of Social and Clinical Psychology 19, 102116.
Grotberg, E (1999). Tapping Your Inner Strength: How to Find the Resilience to Deal with Anything. New Harbinger, Inc.: Oakland, CA.
Hammen, C, Brennan, PA, Keenan-Miller, D, Herr, RA (2008). Early onset recurrent subtype of adolescent depression: clinical and psychosocial correlates. Journal of Child Psychology and Psychiatry 49, 433440.
Hammen, C, Burge, D, Adrian, C (1991). Timing of mother and child depression in a longitudinal study of children at risk. Journal of Consulting and Clinical Psychology 59, 341345.
Hammen, C, Burge, D, Burney, E, Adrian, C (1990). Longitudinal study of diagnoses in children of women with unipolar and bipolar affective disorder. Archives of General Psychiatry 47, 11121117.
Harrington, R, Fudge, H, Rutter, M, Pickles, A, Hill, J (1990). Adult outcomes of childhood and adolescent depression: I. Psychiatric status. Archives of General Psychiatry 47, 465473.
Hazel, NA, Hammen, C, Brennan, PA, Najman, J (2008). Early childhood adversity and adolescent depression: the mediating role of continued stress. Psychological Medicine 38, 581589.
Ingram, RE, Luxton, DD (2005). Vulnerability-stress models. In Development of Psychopathology: A Vulnerability-Stress Perspective(ed. Hankin, B. L. and Abela, J. R. Z.), pp. 3246. Sage Publications: Thousand Oaks, CA.
Kandel, DB, Davies, M (1986). Adult sequelae of adolescent depressive symptoms. Archives of General Psychiatry 43, 255262.
Kasen, S, Chen, H, Sneed, JR, Cohen, P (2010). Earlier stress exposure and subsequent major depression in aging women. International Journal of Geriatric Psychiatry 25, 9199.
Kasen, S, Cohen, P, Skodol, AE, Johnson, JG, Smailes, E, Brook, JS (2001). Childhood depression and adult personality disorder: alternative pathways of continuity. Archives of General Psychiatry 58, 231236.
Kaufman, J, Birmaher, B, Brent, D, Rao, U, Flynn, C, Moreci, P, Williamson, D, Ryan, N (1997). The schedule for affective disorders and schizophrenia for school-age children – present and lifetime version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry 36, 980988.
Kendler, K (1995). Is seeking treatment for depression predicted by a history of depression in relatives? Implications for family studies of affective disorder. Psychological Medicine 25, 807814.
Kendler, KS, Gardner, CO, Prescott, CA (1997). Religion, psychopathology, and substance use and abuse: a multimeasure, genetic-epidemiologic study. American Journal of Psychiatry 154, 322329.
Kendler, KS, Gardner, CO, Prescott, CA (1999 a). Clarifying the relationship between religiosity and psychiatric illness: the impact of covariates and the specificity of buffering effects. Twin Research 2, 137144.
Kendler, KS, Karkowski, LM, Prescott, CA (1999 b). Causal relationship between stressful life events and the onset of major depression. American Journal of Psychiatry 156, 837841.
Kendler, KS, Liu, X-Q, Gardner, CO, McCullough, ME, Larson, D, Prescott, CA (2003). Dimensions of religiosity and their relationship to lifetime psychiatric and substance use disorders. American Journal of Psychiatry 160, 496503.
Kendler, KS, Myers, J (2009). A developmental twin study of church attendance and alcohol and nicotine consumption: a model for analyzing the changing impact of genes and environment. American Journal of Psychiatry 166, 11501155.
Kendler, KS, Thornton, LM, Gardner, CO (2000). Stressful life events and previous episodes in the etiology of major depression in women: an evaluation of the ‘kindling’ hypothesis. American Journal of Psychiatry 157, 12431251.
Kessler, RC (1997). The effects of stressful life events on depression. Annual Review of Psychology 48, 191214.
Kessler, RC, Avenevoli, S, Merikangas, KR (2001). Mood disorders in children and adolescents: an epidemiological perspective. Biological Psychiatry 49, 10021014.
Koenig, HG (1992). Religion and mental health in later life. In Religion and Mental Health (ed. Schumaker, J.), pp. 177188. Oxford University Press: New York.
Koenig, HG, George, LK, Peterson, BL (1998). Religiosity and remission of depression in medically ill older patients. American Journal of Psychiatry 155, 536542.
Koenig, HG, McCullough, ME, Larson, DB (2001). Handbook of Religion and Health. Oxford University Press: New York.
Krause, N (2009). Religious involvement, gratitude, and change in depressive symptoms over time. International Journal for the Psychology of Religion 19, 155172.
Leckman, JF, Sholomskas, D, Thompson, D, Belanger, A, Weissman, MM (1982). Best estimate of lifetime psychiatric diagnosis: a methodological study. Archives of General Psychiatry 39, 879883.
Liang, KY, Zeger, SL (1986). Longitudinal data analyses using generalized linear models. Biometrika 73, 1322.
Luthar, SS (2006). Resilience in development: a synthesis of research across five decades. In Developmental Psychopathology: Risk, Disorder, and Adaptation (ed. Cicchetti, D. and Cohen, D. J.), pp. 740795. Wiley: New York.
Luthar, SS, Cicchetti, D (2000). The construct of resilience: implications for interventions and social policies. Development and Psychopathology 12, 857885.
Luthar, SS, Cicchetti, D, Becker, B (2000). The construct of resilience: a critical evaluation and guidelines for future work. Child Development 71, 543562.
Mannuzza, S, Fyer, AJ, Klein, DF, Endicott, J (1986). Schedule for Affective Disorders and Schizophrenia – Lifetime Version modified for the study of anxiety disorders (SADS-LA): rationale and conceptual development. Journal of Psychiatric Research 20, 317325.
Maselko, J, Gilman, SE, Buka, S (2009). Religious service attendance and spiritual well-being are differentially associated with risk for major depression. Psychological Medicine 39, 10091017.
Masten, A, Best, K, Garmezy, N (1990). Resilience and development: contributions from the study of children who overcome adversity. Development and Psychopathology 2, 425444.
Maton, K (1989). The stress-buffering role of spiritual support: cross-sectional and prospective investigations. Journal for the Scientific Study of Religion 28, 310323.
McCullough, ME, Larson, DB (1998). Future directions in research. In Handbook of Religion and Mental Health (ed. Koenig, H. G.), pp. 95–107. Academic Press: San Diego, CA.
McCullough, ME, Larson, DB (1999). Religion and depression: a review of the literature. Twin Research 2, 126136.
Miller, L, Warner, V, Wickramaratne, P, Weissman, M (1997). Religiosity and depression: ten-year follow-up of depressed mothers and offspring. Journal of the American Academy of Child and Adolescent Psychiatry 36, 14161425.
Miller, L, Wickramaratne, P, Gameroff, MJ, Sage, M, Tenke, C, Warner, V, Weissman, MM (in press). Religiosity and major depressive disorder in adults at high risk: a ten-year prospective study. American Journal of Psychiatry.
Monroe, SM, Simons, AD (1991). Diathesis-stress theories in the context of life stress research: implications for the depressive disorders. Psychological Bulletin 110, 406425.
Ní Raghallaigh, M, Gilligan, R (2010). Active survival in the lives of unaccompanied minors: coping strategies, resilience, and the relevance of religion. Child and Family Social Work 15, 226237.
Orvaschel, H, Puig-Antich, J, Chambers, W, Tabrizi, MA, Johnson, R (1982). Retrospective assessment of prepubertal major depression with the Kiddie-SADS-E. Journal of the American Academy of Child Psychiatry 21, 392397.
Orvaschel, H, Walsh-Allis, G, Ye, W (1988). Psychopathology in children of parents with recurrent depression. Journal of Abnormal Child Psychology 16, 1728.
Pargament, KI (1997). The Psychology of Religion and Coping. Guilford Press: New York.
Regier, DA, Kaelber, CT, Rae, DS, Farmer, ME, Knauper, B, Kessler, RC, Norquist, GS (1998). Limitations of diagnostic criteria and assessment instruments for mental disorders. Implications for research and policy. Archives of General Psychiatry 55, 109115.
Robinson, KM, Kaye, J (1994). The relationship between spiritual perspective, social support, and depression in caregiving and noncaregiving wives. Scholarly Inquiry for Nursing Practice: An International Journal 8, 375389.
Rutter, M (1999). Resilience concepts and findings: implications for family therapy. Journal of Family Therapy 21, 119144.
Rutter, M (2000). Resilience reconsidered: conceptual considerations, empirical findings, and policy implications. In Handbook of Early Childhood Intervention, 2nd edn ( ed. Shonkoff, J. P. and Meisels, S. J.), pp. 651682. Cambridge University Press: New York.
Smith, TB, McCullough, ME, Poll, J (2003). Religiousness and depression: evidence for a main effect and the moderating influence of stressful life events. Psychological Bulletin 129, 614636.
Strawbridge, WJ, Shema, SJ, Cohen, RD, Roberts, RE, Kaplan, GA (1998). Religiosity buffers effects of some stress on depression but exacerbates others. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences 53B, S118S126.
Tennant, C (2002). Life events, stress and depression: a review of recent findings. Australian and New Zealand Journal of Psychiatry 36, 173182.
Thearle, MJ, Vance, JC, Najman, JM, Embelton, G, Foster, WJ (1995). Church attendance, religious affiliation and parental responses to sudden infant death, neonatal death and stillbirth. OMEGA: Journal of Death and Dying 31, 5158.
Tsuang, MT, Williams, WM, Simpson, JC, Lyons, MJ (2002). Pilot study of spirituality and mental health in twins. American Journal of Psychiatry 159, 486488.
Vance, T, Maes, HH, Kendler, KS (2010). Genetic and environmental influences on multiple dimensions of religiosity. Journal of Nervous and Mental Disease 198, 755761.
Warner, V, Weissman, MM, Mufson, L, Wickramaratne, P (1999). Grandparents, parents, and grandchildren at high risk for depression: a three-generation study. Journal of the Academy of Child and Adolescent Psychiatry 38, 289296.
Weissman, MM, Gammon, GD, John, K, Merikangas, KR, Warner, V, Prusoff, BR, Sholomskas, D (1987). Children of depressed parents: increased psychopathology and early onset of major depression. Archives of General Psychiatry 44, 847853.
Weissman, MM, Warner, V, Wickramaratne, P, Moreau, D, Olfson, M (1997). Offspring of depressed parents: 10 years later. Archives of General Psychiatry 54, 932940.
Weissman, MM, Wickramaratne, P, Nomura, Y, Warner, V, Pilowski, D, Verdeli, H (2006). Offspring of depressed parents: 20 years later. American Journal of Psychiatry 163, 10011008.
Werner, EE, Smith, RS (1992). Overcoming the Odds: High Risk Children from Birth to Adulthood. Cornell University Press: New York.
Wickramaratne, PJ, Weissman, MM (1998). Onset of psychopathology in offspring by developmental phase and parental depression. Journal of the American Academy of Child and Adolescent Psychiatry 37, 933942.



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