Journal of Prevention & Intervention in the Community
ISSN: 1085-2352 (Print) 1540-7330 (Online) Journal homepage: http://www.tandfonline.com/loi/wpic20
Religious Beliefs About Mental Illness Influence Social Support Preferences Eric D. Wesselmann, Magin Day, William G. Graziano & Eileen F. Doherty To cite this article: Eric D. Wesselmann, Magin Day, William G. Graziano & Eileen F. Doherty (2015) Religious Beliefs About Mental Illness Influence Social Support Preferences, Journal of Prevention & Intervention in the Community, 43:3, 165-174, DOI: 10.1080/10852352.2014.973275 To link to this article: http://dx.doi.org/10.1080/10852352.2014.973275
Published online: 07 Jul 2015.
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Date: 08 November 2015, At: 19:06
Journal of Prevention & Intervention in the Community, 43:165–174, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 1085-2352 print/1540-7330 online DOI: 10.1080/10852352.2014.973275
Religious Beliefs About Mental Illness Influence Social Support Preferences ERIC D. WESSELMANN Downloaded by [Florida Atlantic University] at 19:06 08 November 2015
Department of Psychology, Illinois State University, Normal, Illinois, USA
MAGIN DAY Military Family Research Institute, Purdue University, West Lafayette, Indiana, USA
WILLIAM G. GRAZIANO Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA
EILEEN F. DOHERTY Department of Communication Arts, Marymount Manhattan College, New York, New York, USA
Research demonstrates that social support facilitates recovery from a mental illness. Stigma negatively impacts the social support available to persons with mental illness (PWMIs). We investigated how religious beliefs about mental illness influenced the types of social support individuals would be willing to give PWMIs. Christian participants indicated their denominational affiliation and their religious beliefs about mental illness. We then asked participants to imagine a situation in which their friend had depression. Participants indicated their willingness to give secular and spiritual social support (e.g., secular: recommending medication; spiritual: recommending prayer). Christians’ beliefs that mental illness results from immorality/sinfulness and that mental illnesses have spiritual causes/treatments both predicted preference for giving spiritual social support. Evangelical Christians endorsed more beliefs that mental illnesses have spiritual causes/treatments than Mainline Protestant and Roman Catholic Christians, and they endorsed more preference for giving spiritual social support than Roman Catholic Christians. Address correspondence to Eric D. Wesselmann, Department of Psychology, Illinois State University, Campus Box 4620, Normal, IL 61790, USA. E-mail: [email protected] 165
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KEYWORDS mental illness, religious beliefs, social support, stigma
The religion–prejudice link is complex: Religion can both create and destroy prejudice toward different groups (Allport, 1954). An important factor in determining this link is the specific religious beliefs held about the stigmatized group in question (Laythe, Finkel, Bringle, & Kirkpatrick, 2002). There is scant empirical research concerning religious beliefs about persons with mental illness—a stigmatized group that often suffers from a loss of personal relationships and social support (Farina, 2000), housing opportunities (Page, 1983), and employment (Webber & Orcutt, 1984). It is important for these beliefs to be studied systematically because religious beliefs and religious communities can be an important source of coping and social support resources (Pargament, Ano, & Wachholtz, 2005). However, sometimes religious beliefs and communities can be detrimental if they encourage maladaptive forms of coping or ineffective treatment options (Pargament & Brant, 1998).
SOCIAL SUPPORT AND COPING Social support (also called supportive communication) can be defined as any verbal or nonverbal behavior meant to provide some type of assistance to an individual who is perceived as needing assistance (Burleson & MacGeorge, 2002). These behaviors can happen in a variety of social contexts, and come from either informal (e.g., friends, family, bartenders) or professional sources (e.g., therapists, clergy; Burleson & Holmstrom, 2008). Past research suggests there are four general types of social support, each with a different focus (Arora, 2008). Supportive behaviors categorized as emotional have an empathic concern for the recipient, emphasizing qualities of reassurance, love, and caring. Informational support involves giving the recipient information that may be useful in dealing with their problems. Appraisal support involves information that is relevant to the recipient’s self-appraisal, such as constructive feedback or affirmation about their beliefs or coping behaviors. Instrumental support involves giving the recipient tangible assistance with problem solving or decision making. Social support is often helpful for coping and general psychological wellbeing (Cohen & Wills, 1985; Shaw, Krause, Chatters, Connell, & IngersollDayton, 2004; Symister & Friend, 2003), but can also have negative effects if the recipient perceives the support negatively or if it does not match the needs of the recipient (Bolger & Amarel, 2007). Effective social support (i.e., support that is positively received by the recipient and positively impacts their mood and self-esteem) must take into account the preferences and motives of the recipient, as well as the specific characteristics of the
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recipient’s problem (MacGeorge, Feng, & Thompson, 2008). For example, Wilkum and MacGeorge (2010) found that religious content in social support is often positively perceived by recipients, but their specific religious beliefs (especially religious coping style) can influence the effectiveness of the support. Wilkum and MacGeorge (2010) focused on support within the bereavement context, but by applying this logic to coping with other stressful situations (i.e., mental illness) it is likely that the specific beliefs about each type of stressor will influence the types of social support given and ultimately how they will be received.
RELIGIOUS BELIEFS ABOUT MENTAL ILLNESS The extant empirical data suggests that religious beliefs about mental illness are positively related to secular stigmatizing beliefs about mental illness (Wesselmann & Graziano, 2010). Further, these beliefs can lead to inadequate social support for both persons with mental illness and their families (Rogers, Stanford, & Garland, 2012; Stanford, 2007). Sometimes, members of religious communities actively encourage persons with mental illness to stop taking psychiatric medicines and instead focus on treatments that favor prayer and religious text study (Malony, 1998; Stanford 2007). These beliefs can ultimately influence the type of treatment or psychiatric services individuals will recommend to persons with mental illness (Stanford & Philpott, 2011). Wesselmann and Graziano (2010) identified two separate but related belief factors in Christian participants: beliefs about mental illness being a result of sinful or immoral behavior, and having spiritually oriented causes and treatments. These two factors were positively correlated to negative secular beliefs about mental illness, as well as other individual difference measures typically associated with prejudiced reactions towards various stigmatized groups (i.e., religious fundamentalism and right wing authoritarianism). Participants endorsed these two factors similarly regardless of the mental illness type (e.g., depression vs. schizophrenia). There were denominational differences in endorsement of the SpirituallyOriented Causes/Treatments belief factor. Participants who identified as NonDenominational Christians were more likely to endorse such beliefs than Roman Catholic/Orthodox participants, but there was no difference between Roman Catholic/Orthodox and Protestant participants. It is important to note that this study did not make distinctions between Protestant denominations, and this could be problematic because there is considerable diversity within Protestant denominations concerning physical, mental, and spiritual health (Malony, 1998). This diversity would likely influence beliefs about the causes of and treatments for mental illness. The goal of this research was to investigate how religious beliefs about mental illness influence social support individuals are willing to give others.
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We hypothesized that individuals’ endorsement of the spiritually-oriented causes/treatments belief factor will predict a positive relation with willingness to provide spiritually oriented social support. We had no a priori hypotheses but instead explored the possibility that religious beliefs about mental illness may predict willingness to provide secular social support, and potential denominational differences in willingness to provide spiritually oriented and secular social support.
METHOD Downloaded by [Florida Atlantic University] at 19:06 08 November 2015
Participants Purdue University students (n ¼ 262) in an undergraduate psychology course participated in this study for course credit. Participants identified their current religious affiliation (if any), using a non-exhaustive list of 87 possible affiliations commonly used in General Social Surveys (ranging among various denominations within Western religions, several Eastern religions, atheism and agnosticism; Ellison, 1999). We excluded any participants who indicated “atheist,” “agnostic,” and “no religion” or did not indicate a preference from our analyses. Our remaining sample was predominately Christian (n ¼ 164) with a smaller number of non-Christian participants (n ¼ 39). Due to the large difference in sample size between groups, we restricted our analyses to the Christians. Participants’ average age was 19.21 (SD ¼ 2.67), and was 77% Caucasian, 8% African American, 7% Asian, 8% Multi-Racial/Other or unknown.
Denominational Categories We combined all of the Roman Catholic and Orthodox denominations of Christianity into one category. The majority of participants in this category were Roman Catholic (n ¼ 60), but some participants reported a branch of Orthodox Christianity (n ¼ 3). There are specific theological differences between the Roman Catholic Church and Orthodox Christian Churches, but these denominations are generally considered closer to each other theologically than the myriad Protestant denominations. We utilized the categorization proposed by Steensland and colleagues (2000) to condense the 54 Protestant/Non-denominational affiliations into three basic groups. These groups were constructed based on the affiliations’ shared historical heritage in American Protestantism (Black, n ¼ 2; Evangelical, n ¼ 78; and Mainline Protestant, n ¼ 21).
Procedure Participants entered the lab individually or in groups and completed the measures at individual workstations. Participants indicated their religious
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affiliation and then answered our subsequent measures. Our measures were embedded in various pilot-testing materials.1 These data were collected across two semesters.
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RELIGIOUS
BELIEFS ABOUT MENTAL ILLNESS
We used an established measure of religious beliefs about mental illness (Wesselmann & Graziano, 2010). This measure assessed the morality/sin (9 items, a ¼ .88; e.g., “Moral weakness is the main cause of mental illness.”) and spiritually-oriented causes/treatments belief factors (7 items, a ¼ .77; e.g., “Prayer is the only way to truly fix a mental illness.”). Participants indicated their agreement with each statement (9-point rating scale; 1 ¼ strongly disagree, 9 ¼ strongly agree).2 SOCIAL
SUPPORT FOR MENTAL ILLNESS
We then asked participants to “imagine that a close friend has just disclosed to you that they think they are suffering from depression. This person has mentioned that they are having a really difficult time, and you are the only person they have confided in.” We generated 11 items to measure participants’ willingness to give different types of social support (i.e., appraisal, emotional, informational, and instrumental support; Arora, 2008); we generated both religious and secular versions of each type (Table 1). Participants indicated how likely they would be to do each social support item (7-point rating scale; 1 ¼ not at all likely, 7 ¼ very likely). We chose depression because it is a common mental illness among college students and it is a more recognizable mental illness among laypeople (Wesselmann & Graziano, 2010).
RESULTS The two religious belief factors were positively intercorrelated, r(164) ¼ .55, p < .01, replicating past research (Wesselmann & Graziano, 2010). Because we generated our own items (both spiritually oriented and secular) to measure the different conceptual types of social support, we conducted an exploratory factor analysis to determine the number of factors that emerged. We conducted an exploratory factor analysis using Principle Axis Factoring with Promax rotation; three separate factors had eigenvalues greater than 1.00. The first factor had an eigenvalue of 4.62 and accounted for 42% of the variance, the second factor had an eigenvalue of 2.27 and accounted for 21% of the variance, and the third factor had an eigenvalue of 1.02 and accounted for 9% of the variance (together explaining 72% of the overall variance). Table 1 lists the factor loadings for each item and overall reliability for the factors. Based on the item content, we labeled Factor 1 Spiritual social
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TABLE 1 Exploratory Factor Analysis: Social Support Items Item factor loadings†
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Specific item 1. Offer to take your friend to your church/place of worship and have your friend talk to your spiritual leader. 2. Recommend that they read a particular passage in the Bible (or another spiritual book) to draw strength from. 3. Spend some time and pray together with your friend. 4. Recommend that they see a spiritual leader/pastor for counseling. 5. Recommend they have their pastor/spiritual leader or community pray to have your friend freed from their affliction. 6. Spend some time praying over your friend and asking God for your friend’s deliverance. 7. Offer to help them schedule an appointment with Purdue’s Counseling and Psychological Services. 8. Recommend that they see a therapist at Purdue’s Counseling and Psychological Services for counseling. 9. Offer to do some research in Purdue’s library on what recent developments in psychology suggest for people in your friend’s situation. 10. Lend your friend some money to help pay for any medication recommended by Purdue’s resident psychiatrist. 11. Spend some time over lunch and listen to your friend’s problems.
Factor 1: Spiritual social support (a ¼ .93)
Factor 2: Factor 3: Secular Secular counseling instrumental support support (a ¼ .89) (a ¼ .59)
.89
–.08
–.14
.87
–.11
–.22
.86 .85
–.11 .40). There were no significant differences between the two forms of secular support, Fs < .50, ps > .70.
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TABLE 2 Denominational Descriptive Statistics for Religious Belief and Social Support Factors
Morality/sin
Spiritually oriented causes/ treatments
Spiritual social support
Roman Catholic M ¼ 1.69 (n ¼ 63) (SD ¼ .85) Black Protestant M ¼ 1.00 (n ¼ 2) (SD ¼ .00) Evangelical Protestant M ¼ 1.99 (n ¼ 78) (SD ¼ 1.27) Mainline Protestant M ¼ 1.70 (n ¼ 21) (SD ¼ .93) Total (n ¼ 164) M ¼ 1.83 (SD ¼ 1.09)
M ¼ 2.58 (SD ¼ 1.03) M ¼ 1.71 (SD ¼ .40) M ¼ 3.43 (SD ¼ 1.45) M ¼ 2.43 (SD ¼ 1.09) M ¼ 2.95 (SD ¼ 1.33)
M ¼ 3.51 (SD ¼ 1.61) M ¼ 3.50 (SD ¼ 3.53) M ¼ 4.40 (SD ¼ 1.81) M ¼ 3.74 (SD ¼ 2.03) M ¼ 3.96 (SD ¼ 1.82)
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Denomination
Secular Secular counseling instrumental support support M ¼ 5.78 (SD ¼ 1.37) M ¼ 6.50 (SD ¼ .71) M ¼ 5.61 (SD ¼ 1.42) M ¼ 5.83 (SD ¼ 1.56) M ¼ 5.72 (SD ¼ 1.41)
M ¼ 3.76 (SD ¼ 1.64) M ¼ 3.00 (SD ¼ .00) M ¼ 3.59 (SD ¼ 1.65) M ¼ 3.86 (SD ¼ 1.82) M ¼ 3.68 (SD ¼ 1.65)
Replicating Wesselmann and Graziano (2010), there were no affiliation differences concerning the morality/sin belief factor, F(3, 160) ¼ 1.43, p ¼ .24; there were differences with the spiritually oriented causes/treatments belief factor, F(3, 160) ¼ 7.38, p < .01. Evangelical Protestant Christians were more likely than Mainline Protestant (Tukey’s HSD p < .01, d ¼ .78) and Roman Catholic Christians (Tukey’s HSD p < .01, d ¼ .68) to endorse the spirituallyoriented causes/treatments belief factor. Participants’ beliefs about morality/sin predicted a preference for spiritual social support (b ¼ .17, p ¼ .02, R2 ¼ .03). These beliefs did not predict either type of secular support (secular counseling b ¼ .06, secular instrumental b ¼ .02, ps > .40, R2s < .01). Participants’ beliefs about spiritually-oriented causes/treatments predicted a preference for spiritual social support (p < .01, b ¼ .53, R2 ¼ .28). These beliefs marginally predicted less preference for secular counseling support (p ¼ .08, b ¼ .14, R2 ¼ .02) but not to Secular instrumental support (b ¼ .12, p ¼ .14, R2 ¼ .01).
DISCUSSION Social support facilitates recovery from stressful life situations such as mental illness. We found evidence that individuals’ religious beliefs influence the types of social support they would be willing to give a hypothetical friend who had a mental illness. Christians’ beliefs that mental illness results from immorality/sinfulness and that mental illnesses have spiritual causes/ treatments both predicted preference for giving spiritual social support to a hypothetical friend with depression. Evangelical Christians endorsed more beliefs that mental illness has spiritual causes/treatments than Mainline
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Protestant and Roman Catholic Christians, and they endorsed more preference for giving spiritual social support than Roman Catholic Christians. These data, to our knowledge, are the first examining preferences for the types of social support religious individuals are willing to give someone with a mental illness. These data are intriguing but have limitations that need to be addressed in future research. First, the factor structure of our social support measure did not support the anticipated conceptual structure found in previous social support literature (Arora, 2008). Rather than finding spiritual and secular equivalents of the four types of social support (i.e., appraisal, emotional, informational, and instrumental support) we instead found three factors: spiritual, secular counseling and secular instrumental support. One item (“Spend some time over lunch and listen to your friend’s problems.”) did not load sufficiently on any factor, even though it was generated to address secular emotional support. One reason may be that we simply generated our own items based on the conceptual definitions of each type of social support rather than adapt an extant social support measure for our purposes. Our exploratory factor analysis suggested a threefactor model but the data are ambiguous as to whether the two secular support factors should be considered distinct. The structure coefficient loadings suggest that the two items we chose to retain for these two factors loaded highly on their respective factors, but all four items technically cross-load on both factors if we consider a loading of .32 or greater as a reason to retain items for each factor (Tabachnick & Fidell, 2007). However, these two secular factors were only modestly positively correlated (r ¼ .41). A confirmatory factor analysis would be needed to examine whether these two factors should be combined or not. These data also only focus on a Christian sample and may not generalize to non-Christian religions. Additionally, we only had two participants in the Black Protestant Christian denomination category so any comparisons between this category and other Christian denominations are suspect. Future research should strive to recruit more participants in these denominations as well as sample from other religions. Future research should investigate if mental illness type influences individuals’ willingness to give different types of spiritual and secular social support. Previous research (Wesselmann & Graziano, 2010) suggests that religious beliefs about mental illness did not differ by illness type but because the current study only used depression we cannot make comparisons for the social support measures. Future research should also investigate how recipients of religious social support respond based on their own religious views about mental illness (Wilkum & MacGeorge, 2010). The current data offer intriguing possibilities for understanding the influence that religious beliefs may have on the social support that individuals are willing to give someone with a mental illness, and how this relation may facilitate (or hinder) coping. Clinicians interested in developing culturally sensitive treatment programs as
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well as researchers interested in creating antistigma campaigns for religious communities should consider these data in their efforts.
NOTES
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1. There was an unrelated scenario experiment at the beginning of the pilot packets. This manipulation had no significant effects (ps > .17) on the relevant measures in this article and thus will not be discussed further. 2. We revised two of the items from the original published scale because previous participants suggested the original wording was awkward. The item “A person’s relationship with God has nothing to do with their suffering from a mental illness.” was revised to “A person suffering from a mental illness has a poor relationship with God.” The item “Prayer is not the only ways to fix a mental illness.” was revised to “Prayer is the only way to truly fix a mental illness.”
REFERENCES Allport, G. W. (1954). The nature of prejudice. New York, NY: Harper & Row. Arora, N. K. (2008). Social support in health communication. In W. Donsbach (Ed.), The international encyclopedia of communication (pp. 4725–4727). Malden, MA: Blackwell. Bolger, N., & Amarel, D. (2007). Effects of social support visibility on adjustments to stress: Experimental evidence. Journal of Personality and Social Psychology, 92, 458–475. Burleson, B. R., & Holmstrom, A. J. (2008). Comforting communication. In W. Donsbach (Ed.), The international encyclopedia of communication (Vol. 2, pp. 560–564). Oxford, United Kingdom: Blackwell. Burleson, B. R., & MacGeorge, E. L. (2002). Supportive communication. In M. L. Knapp & J. A. Daly (Eds.), Handbook of interpersonal communication (3rd ed., pp. 374–424). Thousand Oaks, CA: Sage. Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357. Ellison, C. (1999). Religious preference. In Multidimensional measurement of religiousness/spirituality for use in health research: A report of the Fetzer Institute/ National Institute on Aging Working Group (pp. 81–84). Kalamazoo, MI: Fetzer Institute. Farina, A. (2000). The few gains and many losses for those stigmatized by psychiatric disorders. In J. H. Harvey & E. D. Miller (Eds.), Loss and trauma: General and close relationship perspectives (pp. 183–207). Philadelphia, PA: Brunner-Routledge. Laythe, B., Finkel, D. G., Bringle, R. G., & Kirkpatrick, L. A. (2002). Religious fundamentalism as a predictor of prejudice: A two-component model. Journal for the Scientific Study of Religion, 41, 623–635. MacGeorge, E. L., Feng, B., & Thompson, E. R. (2008). “Good” and “bad” advice: How to advise more effectively. In M. T. Motley (Ed.), Studies in applied interpersonal communication (pp. 145–164). Thousand Oaks, CA: Sage. Malony, H. N. (1998). Religion and mental health from the Protestant perspective. In H. G. Koenig (Ed.), Handbook of religion and mental health (pp. 203–211). San Diego, CA: Academic Press.
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Page, S. (1983). Psychiatric stigma: Two studies of behavior when the chips are down. Canadian Journal of Community Mental Health, 2, 13–19. Pargament, K. I., Ano, G. G., & Wachholtz, A. B. (2005). The religious dimension of coping: Advances in theory, research, and practice. In R. F. Paloutzian & C. L. Park (Eds.), Handbook of the psychology of religion and spirituality (pp. 479–495). New York, NY: Guilford Press. Pargament, K. I., & Brant, C. R. (1998). Religion and coping. In H. G. Koenig (Ed.), Handbook of religion and mental health (pp. 112–129). San Diego, CA: Academic Press. Rogers, E. B., Stanford, M., & Garland, D. R. (2012). The effects of mental illness on families within faith communities. Mental Health, Religion, & Culture, 15, 301–313. Shaw, B. A., Krause, N., Chatters, L. M., Connell, C. M., & Ingersoll-Dayton, B. (2004). Emotional support from parents early in life, aging, and health. Psychology and Aging, 19, 4–12. Stanford, M. S. (2007). Demon or disorder: A survey of attitudes toward mental illness in the Christian church. Mental Health, Religion, & Culture, 10, 445–449. Stanford, M. S., & Philpott, D. (2011). Baptist senior pastors’ knowledge and perceptions of mental illness. Mental Health, Religion, & Culture, 14, 281–290. Steensland, B., Park, J. Z., Regnerus, M. D., Robinson, L. D., Wilcox, W. B., & Woodberry, R. D. (2000). The measure of American religion: Toward improving the state of the art. Social Forces, 79, 291–318. Symister, P., & Friend, R. (2003). The influence of social support and problematic support on optimism and depression in chronic illness: A prospective study evaluating self-esteem as a mediator. Health Psychology, 22, 123–129. Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston, MA: Pearson Education. Webber, A., & Orcutt, J. D. (1984). Employers’ reactions to racial and psychiatric stigmata: A field experiment. Deviant behavior, 5, 327–336. Wesselmann, E. D., & Graziano, W. G. (2010). Sinful and/or possessed? Religious beliefs and mental illness stigma. Journal of Social and Clinical Psychology, 29, 402–437. Wilkum, K., & MacGeorge, E. L. (2010). Does God matter? Religious content and the evaluation of comforting messages in the context of bereavement. Communication Research, 37, 723–745.
ISSN: 1085-2352 (Print) 1540-7330 (Online) Journal homepage: http://www.tandfonline.com/loi/wpic20
Religious Beliefs About Mental Illness Influence Social Support Preferences Eric D. Wesselmann, Magin Day, William G. Graziano & Eileen F. Doherty To cite this article: Eric D. Wesselmann, Magin Day, William G. Graziano & Eileen F. Doherty (2015) Religious Beliefs About Mental Illness Influence Social Support Preferences, Journal of Prevention & Intervention in the Community, 43:3, 165-174, DOI: 10.1080/10852352.2014.973275 To link to this article: http://dx.doi.org/10.1080/10852352.2014.973275
Published online: 07 Jul 2015.
Submit your article to this journal
Article views: 64
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=wpic20 Download by: [Florida Atlantic University]
Date: 08 November 2015, At: 19:06
Journal of Prevention & Intervention in the Community, 43:165–174, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 1085-2352 print/1540-7330 online DOI: 10.1080/10852352.2014.973275
Religious Beliefs About Mental Illness Influence Social Support Preferences ERIC D. WESSELMANN Downloaded by [Florida Atlantic University] at 19:06 08 November 2015
Department of Psychology, Illinois State University, Normal, Illinois, USA
MAGIN DAY Military Family Research Institute, Purdue University, West Lafayette, Indiana, USA
WILLIAM G. GRAZIANO Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA
EILEEN F. DOHERTY Department of Communication Arts, Marymount Manhattan College, New York, New York, USA
Research demonstrates that social support facilitates recovery from a mental illness. Stigma negatively impacts the social support available to persons with mental illness (PWMIs). We investigated how religious beliefs about mental illness influenced the types of social support individuals would be willing to give PWMIs. Christian participants indicated their denominational affiliation and their religious beliefs about mental illness. We then asked participants to imagine a situation in which their friend had depression. Participants indicated their willingness to give secular and spiritual social support (e.g., secular: recommending medication; spiritual: recommending prayer). Christians’ beliefs that mental illness results from immorality/sinfulness and that mental illnesses have spiritual causes/treatments both predicted preference for giving spiritual social support. Evangelical Christians endorsed more beliefs that mental illnesses have spiritual causes/treatments than Mainline Protestant and Roman Catholic Christians, and they endorsed more preference for giving spiritual social support than Roman Catholic Christians. Address correspondence to Eric D. Wesselmann, Department of Psychology, Illinois State University, Campus Box 4620, Normal, IL 61790, USA. E-mail: [email protected] 165
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KEYWORDS mental illness, religious beliefs, social support, stigma
The religion–prejudice link is complex: Religion can both create and destroy prejudice toward different groups (Allport, 1954). An important factor in determining this link is the specific religious beliefs held about the stigmatized group in question (Laythe, Finkel, Bringle, & Kirkpatrick, 2002). There is scant empirical research concerning religious beliefs about persons with mental illness—a stigmatized group that often suffers from a loss of personal relationships and social support (Farina, 2000), housing opportunities (Page, 1983), and employment (Webber & Orcutt, 1984). It is important for these beliefs to be studied systematically because religious beliefs and religious communities can be an important source of coping and social support resources (Pargament, Ano, & Wachholtz, 2005). However, sometimes religious beliefs and communities can be detrimental if they encourage maladaptive forms of coping or ineffective treatment options (Pargament & Brant, 1998).
SOCIAL SUPPORT AND COPING Social support (also called supportive communication) can be defined as any verbal or nonverbal behavior meant to provide some type of assistance to an individual who is perceived as needing assistance (Burleson & MacGeorge, 2002). These behaviors can happen in a variety of social contexts, and come from either informal (e.g., friends, family, bartenders) or professional sources (e.g., therapists, clergy; Burleson & Holmstrom, 2008). Past research suggests there are four general types of social support, each with a different focus (Arora, 2008). Supportive behaviors categorized as emotional have an empathic concern for the recipient, emphasizing qualities of reassurance, love, and caring. Informational support involves giving the recipient information that may be useful in dealing with their problems. Appraisal support involves information that is relevant to the recipient’s self-appraisal, such as constructive feedback or affirmation about their beliefs or coping behaviors. Instrumental support involves giving the recipient tangible assistance with problem solving or decision making. Social support is often helpful for coping and general psychological wellbeing (Cohen & Wills, 1985; Shaw, Krause, Chatters, Connell, & IngersollDayton, 2004; Symister & Friend, 2003), but can also have negative effects if the recipient perceives the support negatively or if it does not match the needs of the recipient (Bolger & Amarel, 2007). Effective social support (i.e., support that is positively received by the recipient and positively impacts their mood and self-esteem) must take into account the preferences and motives of the recipient, as well as the specific characteristics of the
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recipient’s problem (MacGeorge, Feng, & Thompson, 2008). For example, Wilkum and MacGeorge (2010) found that religious content in social support is often positively perceived by recipients, but their specific religious beliefs (especially religious coping style) can influence the effectiveness of the support. Wilkum and MacGeorge (2010) focused on support within the bereavement context, but by applying this logic to coping with other stressful situations (i.e., mental illness) it is likely that the specific beliefs about each type of stressor will influence the types of social support given and ultimately how they will be received.
RELIGIOUS BELIEFS ABOUT MENTAL ILLNESS The extant empirical data suggests that religious beliefs about mental illness are positively related to secular stigmatizing beliefs about mental illness (Wesselmann & Graziano, 2010). Further, these beliefs can lead to inadequate social support for both persons with mental illness and their families (Rogers, Stanford, & Garland, 2012; Stanford, 2007). Sometimes, members of religious communities actively encourage persons with mental illness to stop taking psychiatric medicines and instead focus on treatments that favor prayer and religious text study (Malony, 1998; Stanford 2007). These beliefs can ultimately influence the type of treatment or psychiatric services individuals will recommend to persons with mental illness (Stanford & Philpott, 2011). Wesselmann and Graziano (2010) identified two separate but related belief factors in Christian participants: beliefs about mental illness being a result of sinful or immoral behavior, and having spiritually oriented causes and treatments. These two factors were positively correlated to negative secular beliefs about mental illness, as well as other individual difference measures typically associated with prejudiced reactions towards various stigmatized groups (i.e., religious fundamentalism and right wing authoritarianism). Participants endorsed these two factors similarly regardless of the mental illness type (e.g., depression vs. schizophrenia). There were denominational differences in endorsement of the SpirituallyOriented Causes/Treatments belief factor. Participants who identified as NonDenominational Christians were more likely to endorse such beliefs than Roman Catholic/Orthodox participants, but there was no difference between Roman Catholic/Orthodox and Protestant participants. It is important to note that this study did not make distinctions between Protestant denominations, and this could be problematic because there is considerable diversity within Protestant denominations concerning physical, mental, and spiritual health (Malony, 1998). This diversity would likely influence beliefs about the causes of and treatments for mental illness. The goal of this research was to investigate how religious beliefs about mental illness influence social support individuals are willing to give others.
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We hypothesized that individuals’ endorsement of the spiritually-oriented causes/treatments belief factor will predict a positive relation with willingness to provide spiritually oriented social support. We had no a priori hypotheses but instead explored the possibility that religious beliefs about mental illness may predict willingness to provide secular social support, and potential denominational differences in willingness to provide spiritually oriented and secular social support.
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Participants Purdue University students (n ¼ 262) in an undergraduate psychology course participated in this study for course credit. Participants identified their current religious affiliation (if any), using a non-exhaustive list of 87 possible affiliations commonly used in General Social Surveys (ranging among various denominations within Western religions, several Eastern religions, atheism and agnosticism; Ellison, 1999). We excluded any participants who indicated “atheist,” “agnostic,” and “no religion” or did not indicate a preference from our analyses. Our remaining sample was predominately Christian (n ¼ 164) with a smaller number of non-Christian participants (n ¼ 39). Due to the large difference in sample size between groups, we restricted our analyses to the Christians. Participants’ average age was 19.21 (SD ¼ 2.67), and was 77% Caucasian, 8% African American, 7% Asian, 8% Multi-Racial/Other or unknown.
Denominational Categories We combined all of the Roman Catholic and Orthodox denominations of Christianity into one category. The majority of participants in this category were Roman Catholic (n ¼ 60), but some participants reported a branch of Orthodox Christianity (n ¼ 3). There are specific theological differences between the Roman Catholic Church and Orthodox Christian Churches, but these denominations are generally considered closer to each other theologically than the myriad Protestant denominations. We utilized the categorization proposed by Steensland and colleagues (2000) to condense the 54 Protestant/Non-denominational affiliations into three basic groups. These groups were constructed based on the affiliations’ shared historical heritage in American Protestantism (Black, n ¼ 2; Evangelical, n ¼ 78; and Mainline Protestant, n ¼ 21).
Procedure Participants entered the lab individually or in groups and completed the measures at individual workstations. Participants indicated their religious
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affiliation and then answered our subsequent measures. Our measures were embedded in various pilot-testing materials.1 These data were collected across two semesters.
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RELIGIOUS
BELIEFS ABOUT MENTAL ILLNESS
We used an established measure of religious beliefs about mental illness (Wesselmann & Graziano, 2010). This measure assessed the morality/sin (9 items, a ¼ .88; e.g., “Moral weakness is the main cause of mental illness.”) and spiritually-oriented causes/treatments belief factors (7 items, a ¼ .77; e.g., “Prayer is the only way to truly fix a mental illness.”). Participants indicated their agreement with each statement (9-point rating scale; 1 ¼ strongly disagree, 9 ¼ strongly agree).2 SOCIAL
SUPPORT FOR MENTAL ILLNESS
We then asked participants to “imagine that a close friend has just disclosed to you that they think they are suffering from depression. This person has mentioned that they are having a really difficult time, and you are the only person they have confided in.” We generated 11 items to measure participants’ willingness to give different types of social support (i.e., appraisal, emotional, informational, and instrumental support; Arora, 2008); we generated both religious and secular versions of each type (Table 1). Participants indicated how likely they would be to do each social support item (7-point rating scale; 1 ¼ not at all likely, 7 ¼ very likely). We chose depression because it is a common mental illness among college students and it is a more recognizable mental illness among laypeople (Wesselmann & Graziano, 2010).
RESULTS The two religious belief factors were positively intercorrelated, r(164) ¼ .55, p < .01, replicating past research (Wesselmann & Graziano, 2010). Because we generated our own items (both spiritually oriented and secular) to measure the different conceptual types of social support, we conducted an exploratory factor analysis to determine the number of factors that emerged. We conducted an exploratory factor analysis using Principle Axis Factoring with Promax rotation; three separate factors had eigenvalues greater than 1.00. The first factor had an eigenvalue of 4.62 and accounted for 42% of the variance, the second factor had an eigenvalue of 2.27 and accounted for 21% of the variance, and the third factor had an eigenvalue of 1.02 and accounted for 9% of the variance (together explaining 72% of the overall variance). Table 1 lists the factor loadings for each item and overall reliability for the factors. Based on the item content, we labeled Factor 1 Spiritual social
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TABLE 1 Exploratory Factor Analysis: Social Support Items Item factor loadings†
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Specific item 1. Offer to take your friend to your church/place of worship and have your friend talk to your spiritual leader. 2. Recommend that they read a particular passage in the Bible (or another spiritual book) to draw strength from. 3. Spend some time and pray together with your friend. 4. Recommend that they see a spiritual leader/pastor for counseling. 5. Recommend they have their pastor/spiritual leader or community pray to have your friend freed from their affliction. 6. Spend some time praying over your friend and asking God for your friend’s deliverance. 7. Offer to help them schedule an appointment with Purdue’s Counseling and Psychological Services. 8. Recommend that they see a therapist at Purdue’s Counseling and Psychological Services for counseling. 9. Offer to do some research in Purdue’s library on what recent developments in psychology suggest for people in your friend’s situation. 10. Lend your friend some money to help pay for any medication recommended by Purdue’s resident psychiatrist. 11. Spend some time over lunch and listen to your friend’s problems.
Factor 1: Spiritual social support (a ¼ .93)
Factor 2: Factor 3: Secular Secular counseling instrumental support support (a ¼ .89) (a ¼ .59)
.89
–.08
–.14
.87
–.11
–.22
.86 .85
–.11 .40). There were no significant differences between the two forms of secular support, Fs < .50, ps > .70.
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TABLE 2 Denominational Descriptive Statistics for Religious Belief and Social Support Factors
Morality/sin
Spiritually oriented causes/ treatments
Spiritual social support
Roman Catholic M ¼ 1.69 (n ¼ 63) (SD ¼ .85) Black Protestant M ¼ 1.00 (n ¼ 2) (SD ¼ .00) Evangelical Protestant M ¼ 1.99 (n ¼ 78) (SD ¼ 1.27) Mainline Protestant M ¼ 1.70 (n ¼ 21) (SD ¼ .93) Total (n ¼ 164) M ¼ 1.83 (SD ¼ 1.09)
M ¼ 2.58 (SD ¼ 1.03) M ¼ 1.71 (SD ¼ .40) M ¼ 3.43 (SD ¼ 1.45) M ¼ 2.43 (SD ¼ 1.09) M ¼ 2.95 (SD ¼ 1.33)
M ¼ 3.51 (SD ¼ 1.61) M ¼ 3.50 (SD ¼ 3.53) M ¼ 4.40 (SD ¼ 1.81) M ¼ 3.74 (SD ¼ 2.03) M ¼ 3.96 (SD ¼ 1.82)
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Denomination
Secular Secular counseling instrumental support support M ¼ 5.78 (SD ¼ 1.37) M ¼ 6.50 (SD ¼ .71) M ¼ 5.61 (SD ¼ 1.42) M ¼ 5.83 (SD ¼ 1.56) M ¼ 5.72 (SD ¼ 1.41)
M ¼ 3.76 (SD ¼ 1.64) M ¼ 3.00 (SD ¼ .00) M ¼ 3.59 (SD ¼ 1.65) M ¼ 3.86 (SD ¼ 1.82) M ¼ 3.68 (SD ¼ 1.65)
Replicating Wesselmann and Graziano (2010), there were no affiliation differences concerning the morality/sin belief factor, F(3, 160) ¼ 1.43, p ¼ .24; there were differences with the spiritually oriented causes/treatments belief factor, F(3, 160) ¼ 7.38, p < .01. Evangelical Protestant Christians were more likely than Mainline Protestant (Tukey’s HSD p < .01, d ¼ .78) and Roman Catholic Christians (Tukey’s HSD p < .01, d ¼ .68) to endorse the spirituallyoriented causes/treatments belief factor. Participants’ beliefs about morality/sin predicted a preference for spiritual social support (b ¼ .17, p ¼ .02, R2 ¼ .03). These beliefs did not predict either type of secular support (secular counseling b ¼ .06, secular instrumental b ¼ .02, ps > .40, R2s < .01). Participants’ beliefs about spiritually-oriented causes/treatments predicted a preference for spiritual social support (p < .01, b ¼ .53, R2 ¼ .28). These beliefs marginally predicted less preference for secular counseling support (p ¼ .08, b ¼ .14, R2 ¼ .02) but not to Secular instrumental support (b ¼ .12, p ¼ .14, R2 ¼ .01).
DISCUSSION Social support facilitates recovery from stressful life situations such as mental illness. We found evidence that individuals’ religious beliefs influence the types of social support they would be willing to give a hypothetical friend who had a mental illness. Christians’ beliefs that mental illness results from immorality/sinfulness and that mental illnesses have spiritual causes/ treatments both predicted preference for giving spiritual social support to a hypothetical friend with depression. Evangelical Christians endorsed more beliefs that mental illness has spiritual causes/treatments than Mainline
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Protestant and Roman Catholic Christians, and they endorsed more preference for giving spiritual social support than Roman Catholic Christians. These data, to our knowledge, are the first examining preferences for the types of social support religious individuals are willing to give someone with a mental illness. These data are intriguing but have limitations that need to be addressed in future research. First, the factor structure of our social support measure did not support the anticipated conceptual structure found in previous social support literature (Arora, 2008). Rather than finding spiritual and secular equivalents of the four types of social support (i.e., appraisal, emotional, informational, and instrumental support) we instead found three factors: spiritual, secular counseling and secular instrumental support. One item (“Spend some time over lunch and listen to your friend’s problems.”) did not load sufficiently on any factor, even though it was generated to address secular emotional support. One reason may be that we simply generated our own items based on the conceptual definitions of each type of social support rather than adapt an extant social support measure for our purposes. Our exploratory factor analysis suggested a threefactor model but the data are ambiguous as to whether the two secular support factors should be considered distinct. The structure coefficient loadings suggest that the two items we chose to retain for these two factors loaded highly on their respective factors, but all four items technically cross-load on both factors if we consider a loading of .32 or greater as a reason to retain items for each factor (Tabachnick & Fidell, 2007). However, these two secular factors were only modestly positively correlated (r ¼ .41). A confirmatory factor analysis would be needed to examine whether these two factors should be combined or not. These data also only focus on a Christian sample and may not generalize to non-Christian religions. Additionally, we only had two participants in the Black Protestant Christian denomination category so any comparisons between this category and other Christian denominations are suspect. Future research should strive to recruit more participants in these denominations as well as sample from other religions. Future research should investigate if mental illness type influences individuals’ willingness to give different types of spiritual and secular social support. Previous research (Wesselmann & Graziano, 2010) suggests that religious beliefs about mental illness did not differ by illness type but because the current study only used depression we cannot make comparisons for the social support measures. Future research should also investigate how recipients of religious social support respond based on their own religious views about mental illness (Wilkum & MacGeorge, 2010). The current data offer intriguing possibilities for understanding the influence that religious beliefs may have on the social support that individuals are willing to give someone with a mental illness, and how this relation may facilitate (or hinder) coping. Clinicians interested in developing culturally sensitive treatment programs as
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well as researchers interested in creating antistigma campaigns for religious communities should consider these data in their efforts.
NOTES
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1. There was an unrelated scenario experiment at the beginning of the pilot packets. This manipulation had no significant effects (ps > .17) on the relevant measures in this article and thus will not be discussed further. 2. We revised two of the items from the original published scale because previous participants suggested the original wording was awkward. The item “A person’s relationship with God has nothing to do with their suffering from a mental illness.” was revised to “A person suffering from a mental illness has a poor relationship with God.” The item “Prayer is not the only ways to fix a mental illness.” was revised to “Prayer is the only way to truly fix a mental illness.”
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