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Spiritual Struggles and Ministry-Related Quality of Life Among Faith Leaders in Colombia
Abstract
Faith leaders who are working to promote justice and healing in Colombia might confront stressful circumstances that challenge their spiritual meaning systems and limit ministry-related quality of life. However, whether focusing on domestic or international samples, research has not examined potential effects of spiritual struggles on ministry-related quality of life. In total, 166 faith leaders who were serving in Christian churches and organizations in Colombia completed a Spanish version of Exline, Pargament, Grubbs, and Yali’s (2014) Religious and Spiritual Struggles Scale along with assessments of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) symptomatology. The relative frequencies of different types of spiritual struggles in the sample were as follows: divine = 5.4%, morality = 29.9%, ultimate meaning = 18%, interpersonal = 18%, and doubting = 16.2%. Bivariate results revealed that severity of each of these struggles was concurrently linked with more mental health symptomatology as well as less compassion satisfaction and greater secondary traumatic stress in relation to ministry-related experiences. In addition, when accounting for symptom severity of PTSD and MDD, structural equation modeling results revealed that participants who were experiencing greater moral struggles were particularly vulnerable for struggling in their ministry role at the time of this study. These findings support the need for more research on this topic as well as the possible development of strategies for addressing the emotional, spiritual, and educational needs of faith leaders in Colombia and other nations who are serving persons in contexts of trauma, loss, and displacement.
... The RSS was also used in Colombia and Indonesia, but without further validation studies. The Colombian study (Currier et al. 2019) intentionally suppressed the Demonic factor, resulting in a 22-item and 5-factor scale. It only assessed internal consistencies, which ranged between 0.8 and 0.92. ...
... (Abu-Raiya et al. 2015a, Indonesia(Aditya et al. 2019), Poland(Zarzycka et al. 2018); Colombia(Currier et al. 2019) and the Czech Republic(Janů et al. 2018). Christianity has been the most common of the religious affiliations among participants in these studiesGrubbs et al. 2016;Exline et al. 2014), and other religions and samples are less studied. ...
Studies highlight that although the spiritual/religious dimension is commonly used as a re- source for coping with stress and suffering, sometimes this dimension can also be a locus of struggles. The Religious and Spiritual Struggles (RSS) Scale, composed of 26 items (extended version), is an instrument that assesses the presence of six types of spiritual struggles, categorized into three major categories: Intrapersonal, Interpersonal, and Supernatural. More recently, studies have presented a leaner version, with 14 items (short version), also suitable for evaluating religious/spiritual struggles. This study aimed to validate the RSS Scale, in its two versions, in the Brazilian cultural context and was able to attest to its quality and reliability, albeit with small variations. The Brazilian extended version presented six components (similar to the original version) explaining 68.48% of variance and 0.907 of KMO. Two items were withdrawn due to low loadings, but the psychometric qualities of both versions in two different samples (one wide sample and one with LGBTQIA+ individuals) were maintained. The reliability (Cronbach’s alpha) for each one of the six components ranged from 0.78 to 0.88 (24 items) and from 0.73 to 0.83 (14 items). The TLI and CFI were, respectively, 0.934 and 0.945 (24 items) and 0.982 and 0.988 for the short version (14 items). Furthermore, convergent validity tests indicated correlations with the Satisfaction with Life Scale. The RSS Scale (the Brazilian versions with 24 and 14 items), demonstrated reliability in the studied sample and can be applied in clinical and research contexts.
... The RSS was also used in Colombia and Indonesia, but without further validation studies. The Colombian study (Currier et al. 2019) intentionally suppressed the Demonic factor, resulting in a 22-item and 5-factor scale. It only assessed internal consistencies, which ranged between 0.8 and 0.92. ...
... (Abu-Raiya et al. 2015a, Indonesia(Aditya et al. 2019), Poland(Zarzycka et al. 2018); Colombia(Currier et al. 2019) and the Czech Republic(Janů et al. 2018). Christianity has been the most common of the religious affiliations among participants in these studiesGrubbs et al. 2016;Exline et al. 2014), and other religions and samples are less studied. ...
Studies highlight that although the spiritual/religious dimension is commonly used as a re- source for coping with stress and suffering, sometimes this dimension can also be a locus of struggles. The Religious and Spiritual Struggles (RSS) Scale, composed of 26 items (extended version), is an instrument that assesses the presence of six types of spiritual struggles, categorized into three major categories: Intrapersonal, Interpersonal, and Supernatural. More recently, studies have presented a leaner version, with 14 items (short version), also suitable for evaluating religious/spiritual struggles. This study aimed to validate the RSS Scale, in its two versions, in the Brazilian cultural context and was able to attest to its quality and reliability, albeit with small variations. The Brazilian extended version presented six components (similar to the original version) explaining 68.48% of variance and 0.907 of KMO. Two items were withdrawn due to low loadings, but the psychometric qualities of both versions in two different samples (one wide sample and one with LGBTQIA+ individuals) were maintained. The reliability (Cronbach’s alpha) for each one of the six components ranged from 0.78 to 0.88 (24 items) and from 0.73 to 0.83 (14 items). The TLI and CFI were, respectively, 0.934 and 0.945 (24 items) and 0.982 and 0.988 for the short version (14 items). Furthermore, convergent validity tests indicated correlations with the Satisfaction with Life Scale. The RSS Scale (the Brazilian versions with 24 and 14 items), demonstrated reliability in the studied sample and can be applied in clinical and research contexts.
... contrast findings and, therefore, caution is advised when considering results. Three of the studies measured negative religious appraisals; one measured "spiritual dryness" (1; Büssing et al., 2017), one measured "spiritual struggles" (2; Currier et al., 2019), and one measured "conflicted religious coping" (4; Ellison et al., 2010), all of which assessed participants' negative religious appraisals of God, themselves, and the future. The three studies reported small-to-moderate associations between negative religious beliefs and depression [rs of .2 to .49], with the study rated the highest quality of the three reporting the weakest association. ...
Rates of depression in Christian clergy have been reported as being more than three times that of the general population, and some studies have suggested this is associated with a lack of perceived social support or clergy-members' spiritual well-being. This systematic literature review aimed to identify studies of depression in clergy to assess evidence of the association between social support, spiritual well-being, and depression in this group. Effect sizes were standardised across studies and a narrative synthesis used to discuss findings. Higher rates of depression were found across all studies compared with global health estimates and particularly in those at risk of social isolation, specifically Catholic clergy. Small to moderate associations were found between clergy depression and both perceived social support and spiritual well-being. The quality of the studies identified was varied. Further research is required to explore clergy well-being, barriers to support seeking and clergy-members’ spiritual well-being.
... While some studies have shown connections between religious comfort/struggle and different dimensions of well-being (Abu-Raiya et al. 2015;Currier et al. 2019;Krause et al. 2018;Park et al. 2011;Wilt et al. 2016Wilt et al. , 2017, only a few have investigated what makes satisfaction increase or decrease during a religious strain experience (Zarzycka and Puchalska-Wasyl 2019). Although the mechanism linking religiosity with psychological adjustment still remains unclear (Parenteau et al. 2011) because this relationship is very complex (Hebert et al. 2006), some researchers have proven that mediators or moderators play an important role in this association (Zarzycka and Zietek 2019). ...
A growing number of researchers are testing potential problematic forms of religiousness that denote anxieties regarding sacred matters. However, only a few studies have assessed how religious/spiritual struggle is associated with positive outcomes. Because people's coping responses to stressors are key determinants of their well-being, we expected that different coping strategies could be potential mediators between religious problems/tensions and life satisfaction. The research was conducted on a group of 744 Roman Catholics. We used the Religious Comfort and Strain Scale, Satisfaction with Life Scale, and Brief Coping Orientation to Problems Experienced (COPE) questionnaire. The outcomes show that religious comfort correlated positively with life satisfaction, while fear/guilt, negative emotions toward God, and negative social interactions surrounding religion correlated negatively with life satisfaction. Our research amplifies the understanding of the religious/spiritual struggles and life satisfaction relationship, mediated by "secular" coping strategies. It confirms that both religious and secular methods of experiencing different strains seem to coexist with multiple other strategies in the context of broadly understood life satisfaction.
Religious/spiritual struggles (RSS) have been reported as a risk factor for mental health. Therefore, it is justified to explore how this construct may manifest among religious/spiritual people from diverse origins. The aims of this study were to: (1) translate and adapt the RSS Scale from English to Spanish; (2) examine its internal consistency (using α and ω coefficients); (3) explore its concurrent, convergent, and discriminant validity; and (4) examine its factor structure via confirmatory factor analysis (CFA) in a sample of 225 Puerto Rican adults. The Spanish RSS Scale showed excellent psychometric properties. In CFA with robust maximum likelihood estimation, a 25-item Spanish version of the instrument replicated the six-factor structure of the original 26-item English version and showed excellent reliability. The 25-item RSS scale also presented adequate concurrent, convergent, and discriminant validity. This work advances the development of measures of religious and spiritual aspects in Puerto Ricans.
This paper explored how pastors in Central Kenya Conference can experience emotional healing using 40 pastors as participants in the questionnaire and eight pastors’ representatives in the interview as informants. The study employed a questionnaire and an interview protocol as data collection instruments. The questionnaire was administered to the purposively selected participants, five (5) from each of the eight stations. In addition, interviews were conducted with the eight pastors’ representatives to deduce their particular views and perspectives on emotional hurt and healing. Five items emerged: prayer, sermons, good relationships, forgiveness and counselling support as healing strategies. The study thus recommends that for emotional healing and/or wellbeing to take place, pastors should be intentional about prayer, believing in what they preach, reconciling their broken relationships, forgiving in order to be forgiven and embracing counselling services.
Objectives
Using a stress process framework model, the goal of this study was to address the current gap in our understanding of the prevalence and predictive power of specific types of religious/spiritual struggles for mental health outcomes in informal dementia caregivers.
Method
A convenience sample of 156 informal dementia caregivers completed a scale measuring six domains of religious/spiritual struggles, as well as other measures of primary stressors, background/contextual variables, and mental health outcome (depression).
Results
Overall levels of religious/spiritual struggle were low, but 26 percent of the sample were classified as possible cases of clinically significant religious/spiritual struggle for at least one of the six domains. Of this group, 49 percent acknowledged struggles with ultimate meaning. Religious/spiritual struggles predicted greater self-reported depression over and above number of care recipient problem behaviors (primary stressor), caregiver sex, and caregiver personality (i.e. emotional stability). Although no individual domain of religious/spiritual struggle emerged as most salient, caregivers reported significantly more ultimate meaning struggles than demonic or interpersonal struggles.
Conclusion
Consistent with the stress process framework model, religious/spiritual struggles appeared to operate as a secondary stressor for informal dementia caregivers, adding predictive power to background/contextual factors and to primary stressors for the measured outcome of self-reported depression. One-fourth of the sample self-reported potentially clinically significant religious/spiritual struggles, with ultimate meaning struggles most commonly reported. Further research in this area may advance efforts to better equip both secular and religious professionals to provide evidence-based counsel to informal dementia caregivers.
There is growing evidence that a sense of meaning in life may emerge, in part, from the social relationships that people maintain. But it is not clear how the relationship between social ties and a sense of meaning might arise. The purpose of this study is to see if meaning in life is associated with three socially focused virtues: compassion, forgiveness of others, and providing social support to others. In the process, an effort is made to see if these social virtues arise from social relationships in religious institutions. Two main findings emerge from a recent nationwide survey. First, people who are more compassionate, more forgiving, and who help others more often have a stronger sense of meaning in life. Second, individuals who receive more spiritual support from fellow church members are more likely to adopt these social virtues. The theoretical basis of these relationships is discussed.
Moral distress has received much attention in the international nursing literature in recent years. In this article, we describe the evolution of the concept of moral distress among nursing theorists from its initial delineation by the philosopher Jameton to its subsequent deployment as an umbrella concept describing the impact of moral constraints on health professionals and the patients for whom they care. The article raises worries about the way in which the concept of moral distress has been portrayed in some nursing research and expresses concern about the fact that research, so far, has been largely confined to determining the prevalence of experiences of moral distress among nurses. We conclude by proposing a reconsideration, possible reconstruction and multidisciplinary approach to understanding the experiences of all health professionals who have to make difficult moral judgements and decisions in complex situations.
The signing of the truce on 23 June 2016 and the finalisation of peace negotiations on 24 August 2016 marked the end of more than 50 years of continuous armed conflict in Colombia, South America and the transition to 'post conflict' status. According to annual reports from the Internal Displacement Monitoring Centre based in Geneva, Switzerland, Colombia has ranked first or second in numbers of internally displaced persons every year for the past 12 years, making forced migration a defining characteristic of the country. This is based on the personal reflections of a mother and daughter (ER and AdPGR) who were displaced from rural Colombia and resettled in the nation's urban capital of Bogota. They survived the rigors and hardships of displacement and became capable counsellors on a global mental health project, bringing evidence based interventions to a highly traumatised population of internally displaced women in Bogota. Their account speaks to the lived experiences of more than six million Colombian internally displaced 'victims of the armed conflict'. Particularly notable is the description of myriad trauma exposures prior to the moment of displacement. This field report demonstrates how personal accounts are a useful tool for educating clinicians working with these populations.
(C) 2016 War Trauma Foundation, Diemen, The Netherlands
Clergy experience a large number of stressors in their work, including role overload and emotional labor. Although studies have found high rates of depression in clergy, the degree of work-related burnout in clergy compared to other occupations is unknown. The widely used Maslach Burnout Inventory (MBI) measures three aspects of burnout: emotional exhaustion, depersonalization, and personal accomplishment. We sought studies using comparable versions of the MBI for clergy; for social workers, counselors, and teachers because of those occupations’ emotional intensity and labor; and for police and emergency personnel because of the unpredictability and stress-related physiological arousal in those occupations. We found a total of 84 studies and compared the ranges of burnout scores between the studies of clergy, each additional occupation, and MBI published mean norms. Compared to U.S. norms, clergy exhibited moderate rates of burnout. Across the three kinds of burnout, clergy scores were relatively better than those of police and emergency personnel, similar to those of social workers and teachers, and worse than those of counselors. Clergy may benefit from burnout prevention strategies used by counselors. The moderate levels of burnout found for clergy, despite the numerous stressors associated with their occupation, suggest that clergy generally cope well and may be models to study. Overall, there is room for improvement in burnout for all professions, especially police and emergency personnel. It is important to remember the variation within any profession, including clergy, and prevent and address burnout for those in need.
Aims:
Adults who experienced the 1992 and 2008 armed conflicts in the Republic of Georgia were exposed to multiple traumatic events and stressors over many years. The aim was to investigate what coping strategies are used by conflict-affected persons in Georgia and their association with mental disorders.
Method:
A cross-sectional survey was conducted with 3600 adults, representing internally displaced persons (IDPs) from conflicts in the 1990s (n = 1200) and 2008 (n = 1200) and former IDPs who returned to their homes after the 2008 conflict (n = 1200). Post-traumatic stress disorder, depression, anxiety and coping strategies were measured using the Trauma Screening Questionnaire, Patient Health Questionnaire-9, Generalised Anxiety and adapted version of the Brief Coping Inventory, respectively. Descriptive and multivariate regression analyses were used.
Results:
Coping strategies such as use of humour, emotional support, active coping, acceptance and religion were significantly associated with better mental health outcomes. Coping strategies of behavioural and mental disengagement, denial, venting emotions, substance abuse and gambling were significantly associated with poorer mental health outcomes. The reported use of coping strategies varied significantly between men and women for 8 of the 15 strategies addressed.
Conclusions:
Many conflict-affected persons in Georgia are still suffering mental health problems years after the conflicts. A number of specific coping strategies appear to be associated with better mental health and should be encouraged and supported where possible.
The Posttraumatic Stress Disorder Checklist (PCL-5; Weathers et al., 2013) was recently revised to reflect the changed diagnostic criteria for posttraumatic stress disorder (PTSD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). We investigated the psychometric properties of PCL-5 scores in a large cohort (N = 912) of military service members seeking PTSD treatment while stationed in garrison. We examined the internal consistency, convergent and discriminant validity, and DSM-5 factor structure of PCL-5 scores, their sensitivity to clinical change relative to PTSD Symptom Scale-Interview (PSS-I; Foa, Riggs, Dancu, & Rothbaum, 1993) scores, and their diagnostic utility for predicting a PTSD diagnosis based on various measures and scoring rules. PCL-5 scores exhibited high internal consistency. There was strong agreement between the order of hypothesized and observed correlations among PCL-5 and criterion measure scores. The best-fitting structural model was a 7-factor hybrid model (Armour et al., 2015), which demonstrated closer fit than all other models evaluated, including the DSM-5 model. The PCL-5's sensitivity to clinical change, pre- to posttreatment, was comparable with that of the PSS-I. Optimally efficient cut scores for predicting PTSD diagnosis were consistent with prior research with service members (Hoge, Riviere, Wilk, Herrell, & Weathers, 2014). The results indicate that the PCL-5 is a psychometrically sound measure of DSM-5 PTSD symptoms that is useful for identifying provisional PTSD diagnostic status, quantifying PTSD symptom severity, and detecting clinical change over time in PTSD symptoms among service members seeking treatment. (PsycINFO Database Record
Postconventional religious reasoning has been one of the best defined indicators of spiritual/religious development in the literature. Several theorists have suggested that postconventional religiousness emerges only after individuals confront challenges to their spiritual beliefs and assumptions. To investigate this idea, we studied postconventional spiritual/religious development among trauma survivors in an attempt to identify the types of religious challenges most relevant to the development of postconventional religiousness. Individuals who experienced: (a) more total trauma exposure, (b) more religious rifts with others in their faith group or family, (c) lower levels of religious fear and guilt, and (d) lower levels of religious comfort reported higher levels of postconventional religiousness.
This study explores the relationship of personal and organizational characteristics, along with symptoms of depression, and clergy compassion fatigue, burnout, and potential for compassion satisfaction. Ninety-five clergy from a cluster of Lutheran churches in the Mid-Atlantic United States completed anonymous surveys. Results suggested that clergy were at low risk for burnout and moderate risk for compassion fatigue and they had a moderate potential for compassion satisfaction. Results further revealed that years in service and reported depression significantly predicted burnout. The model did not predict risk for compassion fatigue. Similarities and differences between social workers and clergy are discussed, with recommendations for collaboration and support between the two professions.
Medellín is one of the main destinations for Colombian IDPs. People expelled from all over the country, seek the big city to remain anonymous as a way to ensure security and find job opportunities. But displaced people not only arrive to Medellín. This city also produces the highest number of forced exiles in Colombia and an important number of these people remain within its boundary. Intra urban displaced people share problems with those internal exiles that travel longer distances in the search of haven. Both were violently expelled from their homes, had lost belongings and social ties. Also, despite the complex Colombian idp policy, both face lack of protection. But, additionally, those who remain in their home city usually face recognition problems. Authorities deny the idp status, owing to the short distance between their former and their current home. As a consequence, they cannot access relief and protection programs. This paper analyzes intra urban displacement in Medellín and the response given by national and local authorities.
This commentary aims to delineate the distinguishing features of conflict-induced internal displacement in the nation of Colombia, South America. Even as Colombia is currently implementing a spectrum of legal, social, economic, and health programs for “victims of armed conflict,” with particular focus on internally displaced persons (IDPs), the dynamics of forced migration on a mass scale within this country are little known beyond national borders.
T
he authors of this commentary are embarking on a global mental health research program in Bogota, Colombia to define best practices for reaching the displaced population and implementing sustainable, evidence-based screening and intervention for common mental disorders. Presenting the defining characteristics of internal displacement in Colombia provides the context for our work and, more importantly, conveys the compelling and complex nature of this humanitarian crisis. We attempt to demonstrate Colombia’s unique position within the global patterning of internal displacement.
Chaplains play a unique role in the Veterans Affairs (VA) health care systems and have numerous responsibilities. Compassion satisfaction (CS), compassion fatigue (CF), and burnout (BO) are three major phenomenons that have been documented in other helping professions, but little is known about VA Chaplains' professional quality of life. This study examines a national sample of VA Chaplains and their professional quality of life along with associated factors. Two-hundred and seventeen VA Chaplains completed an anonymous Internet survey, and regression analyses were conducted to determine which variables affect professional quality of life. On average, participants report high levels of CS and low levels of CF and BO. Gender, perceived support from VA administration, and mental health (MH) integration were significant predictors for CS. MH integration and perceived support significantly affected CF. Age, MH integration, and perceived support affected BO. Significant interaction effects were found for CF and BO. In summary, younger Chaplains and Chaplains who report low levels of collaboration with MH professionals are most likely to develop CF and BO. This supports continued support from the VA for interdisciplinary initiatives and mentorship of younger Chaplains.
Background
Evidence is lacking on the mental health issues of internally displaced persons, particularly where displacement is prolonged. The COMRAID study was carried out in year 2011 as a comprehensive evaluation of Muslims in North-Western Sri Lanka who had been displaced since 1990 due to conflict, to investigate the prevalence and correlates of common mental disorders.
Methods
A cross-sectional survey was carried out among a randomly selected sample of internally displaced people who had migrated within last 20 years or were born in displacement. The total sample consisted of 450 adults aged 18–65 years selected from 141 settlements. Common mental disorders (CMDs) and post-traumatic stress disorder (PTSD) prevalences were measured using the Patient Health Questionnaire and CIDI sub-scale respectively.
Results
The prevalence of any CMD was 18.8%, and prevalence for subtypes was as follows: somatoform disorder 14.0%, anxiety disorder 1.3%, major depression 5.1%, other depressive syndromes 7.3%. PTSD prevalence was 2.4%. The following factors were significantly associated with CMDs: unemployment (odds ratio 2.8, 95% confidence interval 1.6–4.9), widowed or divorced status (4.9, 2.3–10.1) and food insecurity (1.7, 1.0–2.9).
Conclusions
This is the first study investigating the mental health impact of prolonged forced displacement in post-conflict Sri Lanka. Findings add new insight in to mental health issues faced by internally displaced persons in Sri Lanka and globally, highlighting the need to explore broader mental health issues of vulnerable populations affected by forced displacement.
Because exposure to potentially traumatic events is common (Kessler, Sonnega, Bromet, & Hughes, 1995), the mechanisms through which post-traumatic stress disorder (PTSD) symptoms develop is a critical area of investigation (Ozer, Best, Lipsey, & Weiss, 2003). Among the mechanisms that may predict PTSD symptoms is spiritual struggle, a set of negative religious cognitions related to understanding or responding to stressful events. Although prominent theories emphasize cognitive factors in the development and maintenance of PTSD symptoms, they have not explicitly addressed spiritual struggle. The present prospective study tested the role of spiritual struggle in the development and maintenance of PTSD symptoms following trauma. We assessed exposure to trauma and non-trauma events during the first year of college, spiritual struggle due to the most stressful event, and PTSD symptoms resulting from the index event. Spiritual struggle partially mediated the relationship between trauma and PTSD symptoms. Interestingly, some individual subscales of spiritual struggle (specifically, Punishing God Reappraisal, Reappraisal of God's Powers, and Spiritual Discontent) partially mediated the relationship between trauma and PTSD symptoms; however, reappraisal of the event to evil forces did not relate to PTSD symptoms. These results suggest that spiritual struggle is an important cognitive mechanism for many trauma victims and may have relevance for cognitive therapy for PTSD.
Nearly 2.7 million individuals worldwide are internally displaced (seeking refuge in secure areas of their own country) annually by armed conflict. Although the psychological impact of war has been well documented, less is known about the mental health symptoms of forced displacement among internally displaced persons.
To estimate the prevalence of the most common war-related mental health conditions, symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression, and to assess the association between displacement status and these conditions in postwar Jaffna District, Sri Lanka.
Between July and September 2009, a cross-sectional multistage cluster sample survey was conducted among 1517 Jaffna District households including 2 internally displaced persons camps. The response rate was 92% (1448 respondents, 1409 eligible respondents). Two percent of participants (n = 80) were currently displaced, 29.5% (n = 539) were recently resettled, and 68.5% (n = 790) were long-term residents. Bivariable analyses followed by multivariable logistic regression models were performed to determine the association between displacement status and mental health.
Symptom criteria of PTSD, anxiety, and depression as measured by the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25.
The overall prevalences of symptoms of PTSD, anxiety, and depression were 7.0% (95% confidence interval [CI], 5.1%-9.7%), 32.6% (95% CI, 28.5%-36.9%), and 22.2% (95% CI, 18.2%-26.5%), respectively. Currently displaced participants were more likely to report symptoms of PTSD (odds ratio [OR], 2.71; 95% CI, 1.28-5.73), anxiety (OR, 2.91; 95% CI, 1.89-4.48), and depression (OR, 4.55; 95% CI, 2.47-8.39) compared with long-term residents. Recently resettled residents were more likely to report symptoms of PTSD (OR, 1.96; 95% CI, 1.11-3.47) compared with long-term residents. However, displacement was no longer associated with mental health symptoms after controlling for trauma exposure.
Among residents of Jaffna District in Sri Lanka, prevalence of symptoms of war-related mental health conditions was substantial and significantly associated with displacement status and underlying trauma exposure.
The global refugee crisis requires that researchers, policymakers, and clinicians comprehend the magnitude of the psychological consequences of forced displacement and the factors that moderate them. To date, no empirical synthesis of research on these issues has been undertaken.
To meta-analytically establish the extent of compromised mental health among refugees (including internally displaced persons, asylum seekers, and stateless persons) using a worldwide study sample. Potential moderators of mental health outcomes were examined, including enduring contextual variables (eg, postdisplacement accommodation and economic opportunity) and refugee characteristics.
Published studies (1959-2002) were obtained using broad searches of computerized databases (PsycINFO and PILOTS), manual searches of reference lists, and interviews with prominent authors.
Studies were selected if they investigated a refugee group and at least 1 nonrefugee comparison group and reported 1 or more quantitative group comparison on measures of psychopathology. Fifty-six reports met inclusion criteria (4.4% of identified reports), yielding 59 independent comparisons and including 67,294 participants (22,221 refugees and 45,073 nonrefugees).
Data on study and report characteristics, study participant characteristics, and statistical outcomes were extracted using a coding manual and subjected to blind recoding, which indicated high reliability. Methodological quality information was coded to assess potential sources of bias.
Effect size estimates for the refugee-nonrefugee comparisons were averaged across psychopathology measures within studies and weighted by sample size. The weighted mean effect size was 0.41 (SD, 0.02; range, -1.36 to 2.91 [SE, 0.01]), indicating that refugees had moderately poorer outcomes. Postdisplacement conditions moderated mental health outcomes. Worse outcomes were observed for refugees living in institutional accommodation, experiencing restricted economic opportunity, displaced internally within their own country, repatriated to a country they had previously fled, or whose initiating conflict was unresolved. Refugees who were older, more educated, and female and who had higher predisplacement socioeconomic status and rural residence also had worse outcomes. Methodological differences between studies affected effect sizes.
The sociopolitical context of the refugee experience is associated with refugee mental health. Humanitarian efforts that improve these conditions are likely to have positive impacts.
The 20 year war in northern Uganda between the Lord's Resistance Army and the Ugandan government has resulted in the displacement of up to 2 million people within Uganda. The purpose of the study was to measure rates of post-traumatic stress disorder (PTSD) and depression amongst these internally displaced persons (IDPs), and investigate associated demographic and trauma exposure risk factors.
A cross-sectional multi-staged, random cluster survey with 1210 adult IDPs was conducted in November 2006 in Gulu and Amuru districts of northern Uganda. Levels of exposure to traumatic events and PTSD were measured using the Harvard Trauma Questionnaire (original version), and levels of depression were measured using the Hopkins Symptom Checklist-25. Multivariate logistic regression was used to analyse the association of demographic and trauma exposure variables on the outcomes of PTSD and depression.
Over half (54%) of the respondents met symptom criteria for PTSD, and over two thirds (67%) of respondents met symptom criteria for depression. Over half (58%) of respondents had experienced 8 or more of the 16 trauma events covered in the questionnaire. Factors strongly linked with PTSD and depression included gender, marital status, distance of displacement, experiencing ill health without medical care, experiencing rape or sexual abuse, experiencing lack of food or water, and experiencing higher rates of trauma exposure.
This study provides evidence of exposure to traumatic events and deprivation of essential goods and services suffered by IDPs, and the resultant effect this has upon their mental health. Protection and social and psychological assistance are urgently required to help IDPs in northern Uganda re-build their lives.
Masters, K.S., Vagnini, K.M., & Rush, C.L. (forthcoming). Religion, spirituality and health. In R. LaCaille (Assoc. Ed.) & R. Gurung (Ed.) The Rutledge encyclopedia of psychology in the real world. Routledge: London, UK.
The purpose of the current study was to develop and evaluate a brief manualized psychospiritual treatment program, entitled From Vice to Virtue: A Guide to Personal Transformation and Spiritual Growth , that addresses spiritual struggles of a moral nature. The intervention had 2 main goals: (a) to resolve moral spiritual struggles and cultivate greater virtue in participants’ lives, thereby reducing distress related to such struggles and (b) to promote spiritual growth by assisting individuals to draw upon religious and spiritual resources for motivation and strength. Participants were 50 volunteers from a modestly sized nondenominational Christian church in Southern California who were assigned to a treatment or wait-list control condition. They completed measures at pretest, posttest, and 4-week follow-up. Results from a mixed-model analysis of variance (ANOVA) with repeated measures indicated that participants in the experimental condition showed greater improvements in their ability to cultivate virtue and resist vice from pretest to posttest compared with those in the wait-list control condition. After all participants completed the intervention, results from a repeated-measures ANOVA indicated that, on average, they showed improvements on all 4 of the outcome variables of virtue, vice, stress, and spiritual development. These gains were maintained at 4-week follow-up. These findings support the efficacy of the current psychospiritual intervention for treating moral spiritual struggles. We discuss the limitations of the study and its implications for research on spiritual struggles; psychospiritual interventions; and virtue, vice, and character education.
Although religion and spirituality often bring comfort and hope, people can also experience religious/spiritual (r/s) struggles in multiple domains: divine, demonic, moral, interpersonal, doubt-related, and ultimate meaning. This chapter explores how these types of r/s struggles could relate to challenges and opportunities associated with various aspects of the self-forgiveness process. Our primary aim is to provide a conceptual overview and to generate testable hypotheses, with the broader aim of providing a foundation for more systematic empirical work in the future. We will focus on three aspects of the self-forgiveness process: acknowledging one’s perceived wrongdoing and accepting responsibility, apology/repentance and making amends, and releasing unhelpful negative thoughts and emotions. Although there are many possible ways that challenges with self-forgiveness might lead to r/s struggles and vice versa, successful attempts to work through these challenges could promote relational healing and personal growth.
Research has established that adverse experiences in childhood are far-reaching. Attachment persists into adulthood, impacted by internal structures that make sense of relational experience. Dunbar (1993) has estimated that humans maintain approximately 150 personal relationships, structured in concentric rings of decreasing intimacy within the active social network. However, no literature exists examining the relationship among adverse childhood experiences (ACEs), adult attachment dynamics, and social networks. Relational mission workers (N=84) completed a self-report questionnaire. Hierarchical multiple regressions revealed that, after controlling for Extraversion, ACEs and Global Anxiety attachment were significant predictors of the size of the innermost social network ring, and ACEs predicted the change in ratio between the innermost social network ring and the social network as a whole. Interpersonal, internal factors, such as attachment style, and experiential, external factors, such as ACEs, can impact the structure and size of an individual's social network.
Pastors play a crucial role in promoting well-being and justice in communities throughout the world. Particularly in the context of natural disasters or human-engineered injustice, clergy frequently stand in the gap to attend to the multifaceted needs of impoverished and underserved individuals. However, whether in times of stability or extreme societal need, amassing evidence suggests that the demands of ministry place clergy at risk for burnout and other stress-related concerns that may diminish their capacity to attend to their congregations and communities. As such, there is a pressing need for preventive interventions that may promote physical, emotional, spiritual, and relational aspects of healthy living that may strengthen clergy resilience in the aftermath of complex disasters or other challenging contexts. Originally designed to address the concerns of clergy serving in New Orleans after Hurricane Katrina, the Pastors Empowerment Program (PEP) is an educational intervention that aims to enhance the self-care and psychological resilience of pastors and their spouses/partners serving in the aftermath of trauma or other demanding ministry contexts. Drawing on a case example from one of the pastors who participated in an initial pilot trial of the PEP that was completed in April 2015, the overarching purpose of this paper is to describe the PEP.
Faith is increasingly being recognised as important in developmental work in general, and specifically in addressing gender-based violence. However, this recognition does not mean that the potential of the faith sector for preventing and responding to GBV is effectively being harnessed. This article explores the potential of faith leaders and communities for addressing GBV, as well as the barriers to them realising this potential, by bringing together primary data and findings from several unrelated studies conducted in six African countries and Myanmar, synthesizing different kinds of data on faith sector involvement in GBV prevention and response.
The Posttraumatic Stress Disorder Checklist (PCL) is a widely used DSM-correspondent self-report measure of PTSD symptoms. The PCL was recently revised to reflect DSM-5 changes to the PTSD criteria. In this article, the authors describe the development and initial psychometric evaluation of the PCL for DSM-5 (PCL-5). Psychometric properties of the PCL-5 were examined in 2 studies involving trauma-exposed college students. In Study 1 (N = 278), PCL-5 scores exhibited strong internal consistency (α = .94), test-retest reliability (r = .82), and convergent (rs = .74 to .85) and discriminant (rs = .31 to .60) validity. In addition, confirmatory factor analyses indicated adequate fit with the DSM-5 4-factor model, χ(2) (164) = 455.83, p < .001, standardized root mean square residual (SRMR) = .07, root mean squared error of approximation (RMSEA) = .08, comparative fit index (CFI) = .86, and Tucker-Lewis index (TLI) = .84, and superior fit with recently proposed 6-factor, χ(2) (164) = 318.37, p < .001, SRMR = .05, RMSEA = .06, CFI = .92, and TLI = .90, and 7-factor, χ(2) (164) = 291.32, p < .001, SRMR = .05, RMSEA = .06, CFI = .93, and TLI = .91, models. In Study 2 (N = 558), PCL-5 scores demonstrated similarly strong reliability and validity. Overall, results indicate that the PCL-5 is a psychometrically sound measure of PTSD symptoms. Implications for use of the PCL-5 in a variety of assessment contexts are discussed.
This study is one of the first attempts to examine the relationships between religious and spiritual struggles (r/s struggles) measured comprehensively and indicators of psychological distress (i.e., depressive symptoms, generalized anxiety) and well-being (i.e., satisfaction with life, happiness) using a nationally representative sample of American adults (N = 2,208) dealing with a wide range of major life stressors. In addition, it examines the key question of whether these relationships persist after controlling for potentially confounding psychosocial/religious influences. Correlational analyses revealed that all 5 types of the r/s struggles assessed (i.e., divine, demonic, interpersonal, moral, ultimate-meaning) correlated significantly positively with both depressive symptoms and generalized anxiety, and significantly negatively with both satisfaction with life and happiness. Hierarchical regression analyses indicated that even after controlling for the effects of demographics and other potentially confounding variables (i.e., neuroticism, social isolation, religious commitment) the r/s struggle subscales added unique variance to the prediction of all 4 criterion measures. Theoretical and practical implications of the findings are offered, and the limitations of the study are discussed. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
The nine-item Patient Health Questionnaire depression scale is a dual-purpose instrument that can establish provisional depressive disorder diagnoses as well as grade depression severity.
The vocation of clergy life can be a hazardous journey. Stress and burnout are issues, which are increasingly reported by
clerics. Burnout is defined by a constellation of work related symptoms (Doolittle, Mental Health, Religion & Culture,10(1),
31–38, 2007), with emotional exhaustion recognised as a core component. Despite this recognition the research has not focused on factors
which lead to this state of emotional exhaustion in particular secondary traumatization. The purpose of this article is threefold.
Firstly, it presents the theoretical framework of secondary trauma. Secondly it reviews the literature aligning clergy and
trauma work and thirdly it discuses the emotional and physical toll upon clergy from this aspect of their role.
Humanitarian aid professionals frequently encounter situations in which one is conscious of the morally appropriate action but cannot take it because of institutional obstacles. Dilemmas like this are likely to result in a specific kind of stress reaction at the individual level, labeled as moral stress. In our study, 16 individuals working with international humanitarian aid and rescue operations participated in semistructured interviews, analyzed in accordance with a grounded theory approach. A theoretical model of ethical decision making from a moral stress perspective was developed. The practical implications of the study are discussed.
The last 10 years have witnessed an upsurge of interest in religion and spirituality as a dimension of life that is significant and powerful in its own right. In this chapter, the authors focus on spiritual struggles as a phenomenon of interest for psychology as well as religion, one that can shed further light on not only the spiritual side of life but also the life of the person as a whole. Throughout the chapter, the insights and wisdom gleaned from Jewish and Christian traditions are integrated with emerging psychological research and theory. The chapter begins by examining the meaning of spiritual struggles and presents data indicating that spiritual struggles are not unusual. Next, the authors turn their attention to some of the factors that may lead to spiritual struggles. An emerging body of research that points to the significant implications of spiritual struggles for psychological, social, and physical functioning is then reviewed. The chapter concludes by reviewing examples of psychological and spiritual programs that have been designed to help people address and resolve their struggles. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Aims:
There is a scarcity of data on mental health problems among Sudanese internally displaced persons (IDPs). This study aims to assess the prevalence of mental disorders of IDPs in Sudan, and to determine and compare the association between mental disorders and socio-demographic variables between the rural and urban long-term IDP populations.
Methods:
This cross-sectional study was implemented in two IDP areas in Central Sudan. Data were collected during face-to-face interviews using structured questionnaires to assess socio-demographic factors and the Mini International Neuropsychiatric Interview (MINI) to determine psychiatric diagnoses. A total of 1,876 adults were enrolled from both study areas.
Results:
The overall prevalence of having any mental health disorder in the IDP population was 52.9%. The most common disorders were major depressive disorder (24.3%), generalized anxiety disorder (23.6%), social phobia (14.2%) and post-traumatic stress disorder (12.3%). Years of displacement and education were associated with different mental disorders between the two areas, and there were no gender differences in prevalence of mental disorders in either area.
Conclusion:
This study shows high prevalence rates of mental disorders in both urban and rural IDP populations in Sudan, indicating a need to explore the circumstances for these high rates and to develop appropriate responses.
Hypothesis: Religious strain would mediate the relationship between stress symptoms at baseline and stress symptoms 1 year later.
Seventy-nine people with a history of stressful life events (55 women, 23 men, one unknown gender, average age 58 years) from community churches reported stressful life events, spiritual adjustment, and posttraumatic stress symptoms at initial assessment and 1-year follow-up.
Religious strain mediated the relationship between baseline and follow-up posttraumatic stress symptoms.
Because religious distress contributed to prediction of stress symptoms over time, it appears that religious distress is related to adjustment to stressful life events.
A growing literature examines the correlates and sequelae of spiritual struggles. Particular attention has been focused on
three specific types of such struggles: (a) divine, or troubled relationships with God; (b) interpersonal, or negative social
encounters in religious settings; and (c) intrapsychic, or chronic religious doubting. To date, however, this literature has
focused primarily on one or another type, leaving open the possibility that these are highly correlated and may tap a single,
underlying dimension. Further, because studies have relied mostly on small, specialized samples, it is not clear whether the
associations between spiritual struggles and psychological functioning vary across key subgroups in the US population. Using
data from the 1998 NORC General Social Survey we address these issues. Findings reveal strong and independent associations
between each type of spiritual struggle and psychological distress, and they also show that these patterns are robust across
most population subgroups, except for variations by age and marital status. Implications, study limitations, and directions
for further research are identified.
KeywordsMental health-Religion-Spirituality-Spiritual struggle-Doubt-Negative interaction
Many people see themselves as being in a relationship with God and see this bond as comforting. Yet, perceived relationships with God also carry the potential for experiencing anger toward God, as shown here in studies with the U.S. population (Study 1), undergraduates (Studies 2 and 3), bereaved individuals (Study 4), and cancer survivors (Study 5). These studies addressed 3 fundamental issues regarding anger toward God: perceptions and attributions that predict anger toward God, its prevalence, and its associations with adjustment. Social-cognitive predictors of anger toward God paralleled predictors of interpersonal anger and included holding God responsible for severe harm, attributions of cruelty, difficulty finding meaning, and seeing oneself as a victim. Anger toward God was frequently reported in response to negative events, although positive feelings predominated. Anger and positive feelings toward God showed moderate negative associations. Religiosity and age correlated negatively with anger toward God. Reports of anger toward God were slightly lower among Protestants and African Americans in comparison with other groups (Study 1). Some atheists and agnostics reported anger involving God, particularly on measures emphasizing past experiences (Study 2) and images of a hypothetical God (Study 3). Anger toward God was associated with poorer adjustment to bereavement (Study 4) and cancer (Study 5), particularly when anger remained unresolved over a 1-year period (Study 5). Taken together, these studies suggest that anger toward God is an important dimension of religious and spiritual experience, one that is measurable, widespread, and related to adjustment across various contexts and populations.
While the current knowledge base on the mental health effects of displacement is mainly limited to refugees residing in industrialised countries, this paper examines the impact of war-induced displacement and related risk factors on the mental health of Eastern Congolese adolescents, and compares currently internally displaced adolescents to returnees and non-displaced peers.
Data were collected from a community sample of 819 adolescents aged 13 to 21 years, attending one of 10 selected schools across the Ituri district in the Democratic Republic of Congo. Respondents completed culturally adapted self-report measures of posttraumatic stress symptoms (using the Impact of Event Scale - Revised) and internalising and externalising behaviour problems (by means of the Hopkins Symptoms Checklist - 37 for Adolescents). Associated factors studied were age, sex, parental death, exposure to war-related violence and daily stressors.
Internally displaced persons (IDPs) reported highest mean scores for the IES-R and the HSCL-37A internalising scale, followed by returnees, while non-displaced adolescents scored significantly lower. However, ANCOVA tests showed that posttraumatic stress and internalising symptoms were mainly associated with traumatic exposure and daily stressors and not with displacement status. Externalising problem scores were associated with traumatic exposure, daily stressors and displacement. Remarkably, death of father was associated with fewer externalising problems. Sex was differently associated with internalising and externalising problems through traumatic and daily stressors.
As IDPs are highly exposed to violence and daily stressors, they report most psychological distress, when compared to returnees and non-displaced peers. The distinct mental health outcomes for returned youngsters illustrate how enhancing current socio-economic living conditions of war-affected adolescents could stimulate resilient outcomes, despite former trauma or displacement.
The present study investigated the relationship between spiritual struggles and various types of psychopathology symptoms in individuals who had and had not suffered from a recent illness. Participants completed self-report measures of religious variables and symptoms of psychopathology. Spiritual struggles were assessed by a measure of negative religious coping. As predicted, negative religious coping was significantly linked to various forms of psychopathology, including anxiety, phobic anxiety, depression, paranoid ideation, obsessive-compulsiveness, and somatization, after controlling for demographic and religious variables. In addition, the relationship between negative religious coping and anxiety and phobic anxiety was stronger for individuals who had experienced a recent illness. These results have implications for assessments and interventions targeting spiritual struggles, especially in medical settings.
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