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Spirituality and Multiple Dimensions of Religion Are Associated With
Mental Health in Gay and Bisexual Men: Results From the One Thousand
Strong Cohort
Jonathan M. Lassiter
Center for HIV/AIDS Educational Studies and Training,
New York, New York, and Muhlenberg College
Lena Saleh
Center for HIV/AIDS Educational Studies and Training,
New York, New York
Christian Grov
Center for HIV/AIDS Educational Studies and Training,
New York, New York, and City University of New York
Graduate School of Public Health and Health Policy
Tyrel Starks
Hunter College and the Graduate Center of the City University of
New York and Center for HIV/AIDS Educational Studies
and Training
Ana Ventuneac
Center for HIV/AIDS Educational Studies and Training,
New York, New York
Jeffrey T. Parsons
Hunter College and the Graduate Center of the City University of
New York and Center for HIV/AIDS Educational Studies
and Training
The purpose of this study was to determine the associations between religion, spirituality, and mental health
among gay and bisexual men (GBM). A U.S. national sample of 1,071 GBM completed an online survey that
measured demographic characteristics, religiosity, religious coping, spirituality, and four mental health
constructs (i.e., depressive symptoms, rejection sensitivity, resilience, and social support). Linear regressions
determined the associations between each mental health construct, demographic variables, and the spirituality
and religion variables. Controlling for demographic characteristics, spirituality was negatively associated with
depressive symptoms and rejection sensitivity, and positively associated with resilience and social support (all
p⬍.001). Religiosity was positively associated with rejection sensitivity (p⬍.05) and negatively associated
with resilience (p⬍.01). Religious coping was positively associated with depression (p⬍.001) and rejection
sensitivity (p⬍.05) and negatively associated with resilience (p⬍.05) and social support (p⬍.05). The
interaction of spirituality with religiosity was significantly associated with all mental health variables. In
general, religious GBM with higher levels of spirituality had better mental health outcomes. Public health
interventions and clinical practice aimed at decreasing negative mental health outcomes among GBM may
find it beneficial to integrate spirituality into their work.
Keywords: spirituality, religion, mental health, gay men, bisexual men
Over the past two decades, researchers have consistently found
an association between spirituality, religion, and a wide range of
physical and mental health outcomes in the general population.
However, most of this research has been done with presumed
heterosexual samples. When researchers do examine spirituality
and religion in the lives of sexual minorities, the focus has often
Jonathan M. Lassiter, Center for HIV/AIDS Educational Studies and
Training, New York, New York, and Department of Psychology, Muhlen-
berg College; Lena Saleh, Center for HIV/AIDS Educational Studies and
Training; Christian Grov, Center for HIV/AIDS Educational Studies and
Training, and City University of New York Graduate School of Public
Health and Health Policy; Tyrel Starks, Hunter College and the Graduate
Center of the City University of New York; Center for HIV/AIDS Educa-
tional Studies and Training; Ana Ventuneac, Center for HIV/AIDS Edu-
cational Studies and Training; Jeffrey T. Parsons, Hunter College and the
Graduate Center of the City University of New York; Center for HIV/
AIDS Educational Studies and Training.
The One Thousand Strong study was funded by the National Institutes of
Health/National Institute on Drug Abuse (NIDA; R01 DA 036466: Jeffrey
T. Parsons and Christian Grov). Jonathan M. Lassiter’s effort was sup-
ported by a supplement to the parent grant. We acknowledge other mem-
bers of the One Thousand Strong Study Team (Jonathon Rendina, Mark
Pawson, Michael Castro, Ruben Jimenez, Brett Millar, Chloe Mirzayi,
Raymond Moody, Anita Viswanath, and Thomas Whitfield) and other staff
from the Center for HIV/AIDS Educational Studies and Training
(Qurrat-Ul Ain, Andrew Cortopassi, Chris Hietikko, Doug Keeler, Chris
Murphy, Carlos Ponton, and Brian Salfas). We also thank the staff at
Community Marketing Inc (David Paisley, Thomas Roth, and Heather
Torch) and Patrick Sullivan, Jessica Ingersoll, Deborah Abdul-Ali, and
Doris Igwe at the Emory Center for AIDS Research (P30 AI050409).
Finally, special thanks go to Jeffrey Schulden and Pamela Goodlow at
NIDA. The content is solely the responsibility of the authors and does not
necessarily represent the official views of the National Institutes of Health.
Correspondence concerning this article should be addressed to Jef-
frey T. Parsons, Department of Psychology, Hunter College of City
University of New York, East 695 Park Avenue, New York, NY 10065.
E-mail: jeffrey.parsons@hunter.cuny.edu
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Psychology of Religion and Spirituality © 2017 American Psychological Association
2017, Vol. 0, No. 999, 000 1941-1022/17/$12.00 http://dx.doi.org/10.1037/rel0000146
1
been on how these factors are associated with homonegativity
(Barton, 2010; Walker & Longmire-Avital, 2013). Furthermore, little
is known about how specific dimensions of spirituality and religion
(i.e., religiosity—religious behaviors—and religious coping—“how
the individual is making use of religion to understand and deal
with stressors” Pargament, Koenig, & Perez, 2000, p. 521) impact
both positive and negative mental health outcomes for sexual
minorities. Specifically, studies often focus on sexual minorities’
spiritual and religious behaviors (such as frequency of church
attendance). This emphasis on the behavioral aspects of spirituality
and religion overlooks the functional aspects (i.e., how religion
and spirituality influence one’s life in personal and social ways)
that are crucial to understanding the mechanisms of spirituality and
religion’s impact on health (Ellison & Levin, 1998). Thus, possible
specific mechanisms of religion and spirituality’s associations with
both positive and negative mental health outcomes for sexual
minorities remain understudied. This study sought to address this
gap in the literature by investigating how spirituality and multiple
dimensions of religion influence both positive and negative mental
health outcomes for a national sample of HIV-negative gay and
bisexual men (GBM).
Defining Religion and Spirituality
Religion and spirituality are overlapping but distinct constructs
that focus on one’s relationship with the sacred (Hill et al., 2000;
Oman, 2013; Zinnbauer et al., 1997). Spirituality refers to “the
search for the sacred” (Pargament, Mahoney, Exline, Jones, &
Shafrankse, 2013, p. 14), where “search” refers to “the ongoing
journey of discovery, conservation, and transformation” (p. 15)
and “sacred” refers “not only to concepts of God and higher
powers but also to other aspects of life that are perceived to be
manifestations of the divine or imbued with divinelike qualities,
such as transcendence, immanence, boundlessness, and ultimacy”
(Pargament et al., 2013, p. 14). In turn, “religion” is defined as “the
search for significance that occurs within the context of established
institutions that are designed to facilitate spirituality” (Pargament
et al., 2013, p. 15). Whereas spirituality is most often defined as a
multidimensional and transcendent relationship with the sacred
that is free of boundaries, religion tends to be defined by its
boundaries in its creation of specific rules and criteria for engage-
ment with the sacred (Miller & Thoresen, 2003). In addition,
religion also embraces nonspiritual, social concerns such as poli-
tics and economics, whereas spirituality is most often viewed as a
unique experience that varies for each person (Miller & Thoresen,
2003).
Spirituality and religion have traditionally been treated either as
behavioral or functional in health research (Oman, 2013). Specif-
ically, health research has either focused on how religious behav-
iors (religiosity) and spiritual beliefs relate to health outcomes
(behavioral focus) or how spirituality and religion facilitate coping
and meaning-making related to illness (functional focus). To ad-
dress the functional components of religion, religious coping has
recently begun to be more studied (Pargament et al., 2000). Reli-
gious coping examines how people use their relationships with the
sacred and the established sacred institutions to navigate stressful
events (Ano & Vasconcelles, 2005). Researchers have found this
to be an important health-related cultural factor among both het-
erosexuals and GBM (Woods, Antoni, Ironson, & Kling, 1999).
Spirituality and Religion’s Associations With Mental
Health in General Populations
Several studies have investigated the specific influences of
distinct components of spirituality and religion on mental health in
general (presumed heterosexual) samples. These studies have gen-
erally found mixed results (Hackney & Sanders, 2003; Masters &
Spielmans, 2007; Unterrainer, Lewis, & Fink, 2014). A recent
systematic review found that most studies of religion, religiosity,
spirituality and mental health demonstrated an inverse association
between religious and spiritual involvement and mental disorders
(72%), with limited studies demonstrating mixed results (19%) and
more mental disorders (5%; Bonelli & Koenig, 2013). Greater
spirituality and religion were associated with lower levels of
depression (Bonelli & Koenig, 2013; Cotton, Zebracki, Rosenthal,
Tsevat, & Drotar, 2006; Power & McKinney, 2014), posttraumatic
stress (Arevalo, Prado, & Amaro, 2008), lower risk of suicide
(Cotton et al., 2006), and less perceived stress (Arevalo et al.,
2008). Religious involvement has also been found to be associated
with positive affect, better quality of life, greater life satisfaction
and higher morale (Abu-Raiya, 2013; Shah et al., 2011).
Beyond the positive impact of these factors on health, studies
have shown that they can also have negative consequences on
health. Religion (particularly negative religious coping [e.g., pas-
sive reliance on the sacred; feeling abandoned by the sacred] and
extrinsic religious orientation) and spirituality, to a lesser extent,
have also been associated with poor mental health outcomes (Ol-
son, Trevino, Geske, & Vanderpool, 2012; Rippentrop, Altmaier,
Chen, Found, & Keffala, 2005; Smith, McCullough, & Poll, 2003).
Taken together, these findings demonstrate the duality of spiritu-
ality and religion; they are both risk and protective factors for
health. Although these findings are important, they were demon-
strated in presumed heterosexual samples; the dual impact of
religion and spirituality for the mental health of gay and bisexual
men is an area for exploration.
Spirituality, Religion, and Mental Health Among GBM
Given the homonegative tone of Abrahamic religious traditions,
such as Christianity, Islam and Judaism, research on religion
among GBM has largely focused on its negative association with
mental health (Schuck & Liddle, 2001). Most Abrahamic religious
traditions, to varying degrees, have denounced same-sex behaviors
and described these behaviors as perverse and sinful (Barnes &
Meyer, 2012; Morrow, 2003; Sherkat, 2002; Zea & Nakamura,
2014). In such contexts, religion has been found to be strongly
correlated with negative attitudes toward GBM (Battle & Lemelle,
2002; Herek, 2000; Pitt, 2009). Such attitudes contribute to
homonegative religious experiences (e.g., being shunned from
religious communities) that negatively affects GBM’s mental
health. For example, homonegative religious experiences have
been found to be associated with internalized homophobia, lower
self-esteem, and higher stress over sexual orientation (Barnes &
Meyer, 2012; Hamblin & Gross, 2014; Lassiter & Parsons, 2015;
Shilo & Savaya, 2012; Sowe, Brown, & Taylor, 2014). Unfortu-
nately, these homonegative aspects of religious and spiritual ex-
periences may contribute to mental health disparities (e.g., higher
risks of substance abuse, suicide, depression, and anxiety) among
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2LASSITER ET AL.
sexual minorities (King et al., 2008; Semlyen, King, Varney, &
Hagger-Johnson, 2016).
Considerably less research has examined the positive influ-
ences of religion and spirituality on the lives of GBM. Some
qualitative studies, mostly focused on GBM of color (Foster,
Arnold, Rebchook, & Kegeles, 2011; Jeffries, Dodge, & Sand-
fort, 2008; Jeffries et al., 2014; Seegers, 2007) have found that
religion and spirituality act as protective factors that add mean-
ing to the lives of GBM. In addition, some quantitative studies
have found that religion and spirituality were associated with
positive mental health outcomes such as psychological adjustment,
fewer depressive symptoms, and less substance use among GBM
(Coleman, 2003; Kipke et al., 2007; Lease, Horne, & Noffsinger-
Frazier, 2005; Tan, 2005; Woods et al., 1999). Although there is a
growing body of literature examining the dual impact of religion
and spirituality among GBM, the majority of research in this area
tends to be pathologically oriented. Furthermore, studies focused
on spirituality—as a separate construct from religion that encom-
passes the functional components of spirituality such as meaning-
making and connection to the sacred—and mental health outcomes
are sparse. This is unfortunate given that GBM may consider
spirituality more important than religion in their lives (Halkitis et
al., 2009).
Current Study
This study aimed to address methodological issues and gaps in
the literature pertaining to GBM, religion, spirituality, and mental
health outcomes. Associations of spirituality and multiple dimen-
sions of religion (specifically, religiosity and religious coping)
with both negative (depression and rejection sensitivity) and pos-
itive (resilience and social support) mental health outcomes in a
U.S. national sample of HIV-negative GBM were examined. In
doing so, the goal was to extend existing research on the associ-
ations of spirituality and religion with mental health among GBM
beyond that of negative mental health outcomes, to also include
examination of variables that may be beneficial to mental health.
Informed by Meyer’s minority stress model (2003), we hypothe-
sized that religion and religious coping will act as minority stres-
sors (given the homonegative components of Abrahamic religious
traditions) and directly influence both positive and mental health
outcomes. Specifically, we proposed that religion and religious
coping will be positively associated with depression and rejection
sensitivity and negatively associated with resilience and social
support. Furthermore, we hypothesized that spirituality will be
directly associated with mental health outcomes as well as act as a
coping mechanism for GBM in the presence of possible negative
religious experiences (minority stressors) and moderate the impact
of religion on GBM’s mental health (see Figures 1A and 1B).
Method
Participants and Procedures
The One Thousand Strong panel is a longitudinal study follow-
ing a U.S. national sample of GBM for a period of three years to
better understand resilience and HIV syndemics among HIV-
negative GBM. Analyses for the present paper are based on base-
line data. Participants were identified via Community Marketing
and Insights, Inc (CMI). panel of over 45,000 LGBT individuals,
over 22,000 of whom are gay and bisexual men throughout the
U.S. Through our partnership, CMI was utilized to identify par-
ticipants and briefly screen them for eligibility. Those deemed
preliminary eligible had their contact information shared with the
team, and we then independently followed up full enrollment and
longitudinal assessment. Details regarding enrollment for the panel
have been describe elsewhere (see Grov et al., 2016).
To be eligible, participants had to reside in the U.S., be at least
18 years of age, be biologically male and currently identify as
male, identify as gay or bisexual, report having any type of sex
(i.e., oral, anal, mutual masturbation) with a man in the past year,
self-identify as HIV-negative, be able to complete assessments in
English, have access to the Internet such to complete at-home
online assessments, have access to a device that was capable of
taking a digital photo (e.g., camera phone, digital camera), have an
address to receive mail that was not a P.O. Box, report residential
stability (i.e., have not moved more than twice in the past 6
months) and complete both at-home self-administered rapid HIV
antibody testing (those testing positive were not included in the
panel), as well as self-collected urine and rectal sampling for STI
testing. Please see Grov et al. (2016) for a thorough rationale for
Religiosity
Religious
Coping
Spirituality
Positive
Mental
Health
Outcomes
+
+
-
-
Religiosity
Religious
Coping
Spirituality
Negative
Mental
Health
Outcomes
-
-
+
+
a b
Figure 1. Hypothesized model of direct and indirect effects of spirituality on (a) negative and (b) positive
mental health outcomes.
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3
SPIRITUALITY, RELIGION, AND MENTAL HEALTH OUTCOMES
these eligibility criteria. Enrollment was conducted over a period
of 6 months (April 2014 –October 2014) to maintain sufficient
staffing resources to guide participants through the enrollment
milestones (e.g., mailing HIV/STI testing kits, following up with
participants). The Hunter College Institutional Review Board ap-
proved study procedures.
Measures
Demographics. Participants reported their race and ethnicity,
educational level, relationship status, income, sexual orientation
identity label, current geographical region of residence, and age.
Outcome variables. Depressive symptoms were evaluated
using the Center for Epidemiological Studies—Depression Scale
(CES–D; Radloff, 1977). This 20-item scale with response
options that range from 0 (rarely or none of the time)to3(most
or all of the time) assesses a participant’s experience of the
physiological, cognitive, and psychological symptoms of de-
pression. The item responses were summed for a total score.
Higher scores indicate more depressive symptoms experienced
by the participant (␣⫽.93).
The Rejection Sensitivity Questionnaire (Downey & Feldman,
1996) was used to measure rejection sensitivity, which has been
conceptualized as a person’s general sensitivity to interpersonal
rejection that is neither status-based nor specific to any type of
context. The scale contains nine vignettes that assess a partici-
pant’s level of anxiety and expectancy related to that particular
vignette. Participants rated their anxiety and expectancy on a
Likert scale that ranges from 1 (very unconcerned/very unlikely)to
6(very concerned/very likely). Higher scores indicate higher levels
of rejection sensitivity (␣⫽.67).
Resilience was measured with the 10-item Connor–Davidson
Resilience Scale (Campbell-Sills & Stein, 2007). Participants
rated their agreement with items on a scale of 0 (not true at all)
to4(true nearly all of the time). Higher scores indicate more
resilience (␣⫽.91).
Social support was assessed with the Multidimensional Scale of
Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, &
Farley, 1988). The scale has 12 items that assess the level of social
support one perceives he receives from his significant other, family
members, and friends on a scale that ranges from 1 (very strongly
disagree)to6(very strongly agree). Higher scores indicate higher
levels of perceived social support (␣⫽.92).
Predictor variables. Spirituality and religiosity were mea-
sured using the Ironson-Woods Spirituality/Religiousness Index
(Ironson et al., 2002). This measure was developed and validated
with a racially diverse sample (Ironson et al., 2002) and has since
successfully predicted a range of mental health outcomes including
depression and social support (Bekelman et al., 2010; Monod et
al., 2011). It was used because of its validation with both LGBT
and heterosexual racially diverse people as well as its inclusion of
subscales to assess both spirituality and religion. The Ironson-
Woods Sense of Peace subscale (Ironson et al., 2002) is a 9-item
questionnaire that assesses how participants’ spirituality functions
to help them make meaning of their lives and feel connected to the
sacred. Sample items include “My beliefs give me a sense of
peace” and “My beliefs help me feel I have a relationship or a
connection with a higher form of being.” Participants rated their
agreement with the item on a scale of 1 (strongly disagree)to6
(strongly agree). Higher scores suggest higher levels of spirituality
(␣⫽.95).
Religiosity was assessed using the Ironson-Woods Religious
Behavior subscale (Ironson et al., 2002). It is a 5-item subscale that
assesses participants’ involvement in religious behaviors. Sample
items include “I attend religious services” and “I discuss my
beliefs with others who share my belief.” Participants rated their
agreement with the item on a scale of 1(strongly disagree)to6
(strongly agree). Higher scores suggest higher levels of religiosity
(␣⫽.84).
Religious coping was measured with the Religious Coping
subscale of a modified version of the COPE (Carver, Scheier, &
Weintraub, 1989). There are four items on the subscale. Sample
items include, “I try to find comfort in my religion or spiritual
beliefs,” and “I seek God’s (or a higher power’s) help.” Partici-
pants rated their agreement with the statement on a scale of 1 (I
usually do not do this at all)to4(I usually do this a lot). Higher
scores indicate higher levels of religious coping (␣⫽.95).
Data Analysis
Descriptive analyses for demographic characteristics, spiritual-
ity and religious variables, and mental health outcome variables
were performed. Four linear regressions were conducted, one for
each of the four mental health outcomes of interest: depressive
symptoms, rejection sensitivity, resilience, and social support. The
assumptions of multiple regression were assessed and met. Anal-
yses were conducted using SPSS 22.
Results
Shown in Table 1, the sample was predominately comprised of
White (71.2%), gay-identified (95.0%), college educated (55.7%),
and single (51.3%) men with a mean age of 40. The most endorsed
residential location was the Southeastern region of the United
States (35.2%). In total, 46.3% reported an income of $50,000 or
more a year.
Multivariate Analyses
Table 2 displays the results of the linear regression analyses for
the four mental health outcomes. After controlling for demo-
graphic variables, spirituality was negatively associated with de-
pressive symptoms and rejection sensitivity, and positively asso-
ciated with resilience and social support (all p⬍.001). Religiosity
was positively associated with rejection sensitivity (p⬍.05) and
negatively associated with resilience (p⬍.01). Religious coping
was positively associated with depression (p⬍.001) and rejection
sensitivity (p⬍.05) and negatively associated with resilience (p⬍
.05) and social support (p⬍.05).
The two-way interaction of spirituality and religiosity was sig-
nificantly associated with all outcome variables. Figures 2A
through 2D displays graphical representations of the interaction
term for depressive symptoms, rejection sensitivity, resilience, and
social support. As shown in Figure 2A, GBM who endorsed high
levels of religiosity and spirituality reported experiencing signifi-
cantly less depressive symptoms than GBM who endorsed high
religiosity but low spirituality (M⫽14.68 vs. M⫽27.31). Figure
2B showed a similar pattern in that GBM who endorsed high levels
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4LASSITER ET AL.
of religiosity and spirituality reported significantly lower levels of
rejection sensitivity compared those who endorsed high religiosity
but low spirituality (M⫽12.37 vs. M⫽15.37). When examining
the associations of the interaction of spirituality and religiosity
with positive mental health outcomes, Figures 2C and 2D depict
that GBM who endorsed high levels of religiosity and spirituality
reported significantly higher levels of resilience (M⫽39.70 vs.
M⫽31.85) and social support (M⫽78.13 vs. M⫽64.74)
compared with GBM who endorsed high religiosity but low spir-
ituality.
Discussion
This study analyzed the associations between spirituality and
multiple dimensions of religion, as distinct and overlapping fac-
tors, with both positive and negative mental health outcomes in a
U.S. national sample of HIV-negative GBM. As hypothesized,
spirituality was inversely related to negative mental health out-
comes and positively associated with positive mental health out-
comes. Although spirituality has been defined in multiple ways
(Miller & Thoresen, 2003), researchers have found that LGBT
people emphasize the interpersonal aspects of spirituality that
connect them with the sacred— or higher power(s) or something(s)
divine outside of the self—and other people in ways that allow
them to live morally, gain insight, and develop wisdom (Halkitis et
al., 2009). Given this emphasis, it is not surprising that among
GBM in this sample, spirituality was consistently associated with
positive mental health outcomes and lower levels of negative
mental health outcomes. If spirituality functions as an impetus for
feelings of connectedness, regulation and guidance of lifestyle
behaviors, and insight into self, others, and the world, it makes
sense that the men in this sample would feel better about them-
selves (e.g., be less depressed), be less concerned about others
rejecting or judging them, feel more connected with others, and be
able to work through challenges more effectively.
Hypotheses about the associations between religiosity and men-
tal health outcomes were generally confirmed. As hypothesized,
religiosity was positively associated with rejection sensitivity and
negatively associated with resilience. Many GBM have reported
experiencing homonegativity in religious settings and from reli-
gious people (Barton, 2010; Griffin, 2006). These negative char-
Table 1
Demographic Characteristics (N ⫽1,071)
Characteristic n%
Race/ethnicity
Black 83 7.7
Latino 135 12.6
White 763 71.2
Other/multiracial 90 8.4
Education
No college degree 474 44.3
College degree 597 55.7
Relationship status
Single 549 51.3
In a relationship 522 48.7
Income
Less than 20K 213 19.9
20K to 49K 362 33.8
50K or more 496 46.3
Sexual orientation
Gay 1017 95.0
Bisexual 54 5.0
Geographic region
Southeastern 377 35.2
Northeastern 204 19.0
Midwest 192 17.9
West 297 27.7
U.S. possession 1 0.1
MSD
Age (range ⫽18–79) 40.2 13.8
Spirituality (range ⫽9–45) 27.8 11.2
Religiosity (range ⫽5–25) 11.2 5.7
Religious coping (range ⫽4–16) 7.0 3.8
Depression (range ⫽0–56) 16.5 0.3
Rejection sensitivity (range ⫽1–26) 9.1 0.1
Resilience (range ⫽2–40) 29.5 0.2
Social support (range ⫽12–84) 62.2 0.5
Table 2
Influences of Spirituality, Religiosity, and Religious Coping on Gay and Bisexual Men’s Mental
Health Outcomes
Predictor
Depression Rejection sensitivity
b95% CI R
2
b95% CI R
2
Spirituality ⫺.39
ⴱⴱⴱ
[⫺.49, .29] ⫺.38 ⫺.09
ⴱⴱⴱ
[⫺.12, .06] ⫺.31
Religiosity .16 [⫺.05, .37] .08 .07
ⴱ
[.01, .13] .12
Religious coping .68
ⴱⴱⴱ
[.39, .98] .23 .12
ⴱ
[.03, .20] .13
Spirituality ⫻Religiosity ⫺.03
ⴱⴱⴱ
[⫺.04, ⫺.02] ⫺.16 ⫺.01
ⴱⴱⴱ
[⫺.01, .00] ⫺.14
.15 .10
Resilience Social support
Spirituality .25
ⴱⴱⴱ
[.20, .31] .44 .45
ⴱⴱⴱ
[.32, .57] .33
Religiosity ⫺.16
ⴱⴱ
[⫺.28, ⫺.04] ⫺.14 ⫺.17 [⫺.43, .10] ⫺.06
Religious coping ⫺.18
ⴱ
[⫺.34, ⫺.01] ⫺.10 ⫺.39
ⴱ
[⫺76, .00] ⫺.09
Spirituality ⫻Religiosity .02
ⴱⴱⴱ
[.01, .03] .16 .03
ⴱⴱ
[.01, .04] .10
.12 .22
Note. Race, ethnicity, education, relationship status, income, sexual orientation, geographic region, and age
were controlled for in all models. ⫽standardized regression coefficient or “beta weight.” R
2
⫽percent of the
variance in the dependent variable accounted for in the regression model. N⫽1,071. CI ⫽confidence interval.
ⴱ
p⬍.05.
ⴱⴱ
p⬍.01.
ⴱⴱⴱ
p⬍.001.
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5
SPIRITUALITY, RELIGION, AND MENTAL HEALTH OUTCOMES
acteristics of religion contribute it to acting as a stressor for GBM
instead of a protective factor. The results confirm this possible
detrimental function of religiosity—the behavioral and participa-
tory component of religion—in the lives of GBM. Homonegative
experiences associated with religiosity may negatively influence
GBM’s mental health. Many GBM report feeling rejection due to
their same-sex attractions from their religious organizations, ex-
plicitly by fellow congregants and sometimes implicitly by the
sacred, and from their parents for religious reasons (Griffin, 2006).
This rejection may exacerbate anxious attachment styles and con-
tribute to GBM being overly sensitive to future rejection (Landolt,
Bartholomew, Saffrey, Oram, & Perlman, 2004) and engaging in
detrimental health behaviors inconsistent with resilience (Bradshaw,
Ellison, & Marcum, 2010; Horton, Ellison, Loukas, Downey, &
Barrett, 2012). Contrary to predictions, religiosity was not indepen-
dently associated with depressive symptoms or social support. This
lack of association may be related to the overlapping qualities of
spirituality with religiosity. Specifically, the unique and shared char-
acteristics of spirituality (with religiosity) may be stronger correlates
of depressive symptoms and social support than the distinct charac-
teristics of religiosity alone.
Religious coping was associated with higher levels of depres-
sive symptoms and rejection sensitivity as well as lower levels of
resilience and social support. These findings are consistent with
other studies that have found that passive religious coping can lead
to pathological outcomes (Barber & Gold, 2012; Newman &
Pargament, 1990; Pargament et al., 1988). Although this study
measured religious coping in general, many of the questions as-
sessed what could be considered passive aspects of the construct
and did not specifically tap into the active approach to religious
coping such as partnering with the sacred or looking to the sacred
for support. Furthermore, given many religions’ homonegative
stance toward same-sex attractions, GBM may interpret their life
difficulties to be punishment from God and perceive themselves as
being unable to change them. Forms of religious coping (e.g.,
prayer and seeking help from the sacred) may become about
redemption from sin rather than problem-solving and empower-
ment. With this perspective, religious coping functions as a tool of
distress instead of relief. Therefore, it is not surprising that reli-
gious coping would have a negative association with the mental
health outcomes in this sample.
When interpreting the interaction terms, it seemed that GBM
experienced lower levels of negative mental health and higher
levels of positive mental health when both spirituality and religi-
osity were high. Overall, these findings partly confirmed our
hypotheses. Given that we expected religion and religious coping
to act as minority stressors, due to their homonegative aspects, we
did not anticipate that men with high levels of both religiosity and
spirituality would have better mental health outcomes than men
with low religiosity and high spirituality. Our findings indicate that
religiosity may actually be salubrious for mental health as long as
it is coupled with a high level of spirituality that provides meaning
making and a sense of peace. Furthermore, spirituality may be
related to a buffering effect that lowers the level of negative mental
Figure 2. Moderating effect of spirituality on religiosity’s impact on (a) depression, (b) rejection sensitivity,
(c) resilience, and (d) perceived social support. See the online article for the color version of this figure.
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
6LASSITER ET AL.
health outcomes that GBM experience when they only engage in
religiosity.
This study has important implications for health research with
GBM. It provides new insights into how functional aspects of
spirituality and behavioral components of multiple dimensions of
religion relate to the mental health of GBM. The functionality
of spirituality is more influential and salubrious on GBM’s mental
health than simply engaging in religious behaviors. Engaging in
religious behaviors without the meaning, connectedness, and in-
trinsic morality that was associated with spirituality seemed to be
a detriment to mental well-being. The findings highlight the im-
portance of using multiple measures of religion and spirituality
that tap into the various dimensions of these phenomena. Narrowly
focusing on behavior may cause researchers to miss the complex
ways in which religion and spirituality interact in the lives of
GBM. A better understanding of the mechanisms through which
spirituality may be able to buffer against religiosity’s negative
mental health associations is critical. It may be that highly spiritual
individuals are able to use their personal relationships with the
sacred and intrinsic spirituality to help them selectively reject
nonaffirming aspects of their religious tradition that attempt to
condemn them. Qualitative studies have found that some GBM are
able to use strategies such as personal interpretation of religious
text and questioning the knowledge-level of people who use reli-
gion to justify their homonegative prejudice (Lassiter, 2015; Pitt,
2009). Such strategies allow some GBM to maintain a sense of
spirituality in the face of antigay religious messaging. Research
that aims to understand if similar processes may explain the
potential buffering role of spirituality in the presence of religiosity
is critical to gaining more nuanced knowledge about how religion
and spirituality operates in the lives of GBM.
Public health interventions and clinical practice aimed at de-
creasing negative mental health outcomes among GBM could be
enhanced by the current study’s findings. Integration of religion
and spirituality in mental health interventions may include discuss-
ing how GBM understand the connections of religion, spirituality,
and health in their lives. It may also include helping GBM enhance
spirituality and meaning-making in their lives so that they may
better understand and positively reframe struggles (e.g., homon-
egativity, discrimination, poverty, racism) as opportunities for
spiritual growth and action. Mental health interventionists are
encouraged to integrate programming that aids religiously oriented
GBM in developing higher levels of spirituality and active reli-
gious coping. If GBM are able to engage in active religious coping
that is void of homonegativity and focuses on using their spiritu-
ality, it may empower them to make healthy lifestyle choices and
better cope with health problems. Furthermore, mental health
providers may find it appropriate and beneficial to facilitate their
patients in reconciling their religious and sexual identities (Las-
siter, 2015) and reengaging with homoaffirming religious and
spiritual resources (Bozard & Sanders, 2011). The overall goal is
to maximize the benefits of religion and spirituality and minimize
their negative impact so as to promote positive mental health
among GBM (Lassiter, 2014).
We have interpreted and discussed the scholarly and clinical
implications of our findings but they are not without limitations.
Although this sample does closely mirror the demographic char-
acteristics of the U.S. as well as the distribution of GBM across the
U.S., this sample was composed of predominately White GBM.
Given the inclusion criterion that all men be HIV-negative, many
men of color initially screened via CMI were found to be ineligible
given their HIV-positive serostatus. Therefore, these findings
should be interpreted with caution when applying them to GBM of
color and may not be applicable to HIV-positive GBM. We used
measures that assessed the functional aspects of spirituality and the
behavioral components of religiosity and religious coping, we
would have benefited by having measures that assessed the func-
tional and behavioral characteristics of both spirituality and reli-
gion. Measures that assess both components of both constructs
could add more insight into the particular mechanisms of their
interactions with health. However, to the authors’ knowledge no
such measures with those characteristics exist. Finally, this study
was Web based and the sample was recruited through our partner-
ship with CMI who engaged people who were already familiar
with Web based study procedures. GBM who did not know how to
use a computer or who did not have Internet access were not
eligible to be a CMI panelist and thus are not represented in the
current study.
This study represents a significant contribution to the psycho-
logical literature concerning religion, spirituality, and the mental
health of GBM. These findings provided new insights into the
ways in which spirituality and multiple dimensions of religion are
associated with both positive and negative mental health outcomes
for GBM. Spirituality was consistently associated with positive
mental health outcomes and lower levels of negative ones. Con-
trarily, religiosity—solely expressed through behaviors and devoid
of spirituality—was associated with negative mental health out-
comes. Public health interventionists and mental health providers
are encouraged to incorporate spirituality and religion in their
work with religiously and spiritually oriented GBM to help these
men minimize the negative aspects of these forces and maximize
their salubrious agents to promote positive mental health.
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Received February 19, 2016
Revision received December 30, 2016
Accepted May 7, 2017 䡲
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