Perceptions of Accountability to God and Psychological Well-Being Among US Adults

Abstract

This study examines whether accountability to God is positively associated with four measures of psychological well-being—happiness, mattering to others, dignity, and meaning—among US adults. It also tests the possibility that prayer moderates these associations. Data from the 2017 Values and Beliefs of the American Public Survey (n = 1251) were analyzed using multivariate regression. Findings provided support for an association between accountability to God and mattering to others, dignity, and meaning in fully controlled models, and for happiness when religious controls were excluded. They also showed that these relationships were stronger among those who prayed frequently compared with those who did not. Overall, these findings shed light on a new concept—accountability to God—including its association with psychological well-being.

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Journal of Religion and Health
https://doi.org/10.1007/s10943-021-01471-8
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ORIGINAL PAPER
Perceptions ofAccountability toGod andPsychological
Well‑Being Among US Adults
MattBradshaw1· BlakeVictorKent2 · CharlottevanOyenWitvliet3·
ByronJohnson1· SungJoonJang1· JosephLeman1
Accepted: 23 November 2021
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature
2021
Abstract
This study examines whether accountability to God is positively associated with four
measures of psychological well-being—happiness, mattering to others, dignity, and
meaning—among US adults. It also tests the possibility that prayer moderates these
associations. Data from the 2017 Values and Beliefs of the American Public Survey
(n = 1251) were analyzed using multivariate regression. Findings provided support
for an association between accountability to God and mattering to others, dignity,
and meaning in fully controlled models, and for happiness when religious controls
were excluded. They also showed that these relationships were stronger among those
who prayed frequently compared with those who did not. Overall, these findings
shed light on a new concept—accountability to God—including its association with
psychological well-being.
Keywords Prayer· Virtue· Happiness· Dignity· Meaning
Introduction
Substantial evidence suggests that religious practices and beliefs are consequen-
tial for psychological well-being (PWB), with many studies reporting salutary
associations (Chen etal., 2020; Koenig, 2018; Koenig etal., 2012; VanderWeele,
2017a, 2017b). Investigators have examined an array of religious constructs
including denominational affiliation, service attendance, prayer and meditation,
perceived intimacy with God, religious experiences, and social identities formed
* Matt Bradshaw
drmattbradshaw@gmail.com
1 Institute forStudies ofReligion, Baylor University, One Bear Place #97326, Waco,
TX76798-7326, USA
2 Department ofSociology & Anthropology, Westmont College, SantaBarbara, CA, USA
3 Department ofPsychology, Hope College, Holland, MI, USA

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in religious settings, among others (AbdAleati et al., 2016; Chen et al., 2020;
Dein etal., 2010; Ellison et al., 2009; Hallett etal., 2016; Kent, 2019; Keyes &
Reitzes, 2007; Leman et al., 2018; Miller et al., 2014; Moreira-Almeida etal.,
2006). To date, however, scholars have neglected a potentially important aspect
of religious life: the extent to which people experience a sense of accountability
to God or other transcendent guide for living (Evans, 2018, 2019).
As outlined by Evans (2018), people with a sense of “theistic accountability”
see themselves as answerable to God, look to God as a guide for making deci-
sions in life, welcome the responsibilities of their faith, and view accountability
to God and their religious faith as gifts that help them lead happy and successful
lives (Ano & Vasconcelles, 2005; Ellison & Taylor, 1996; Pargament, 1997). In
this view, embracing accountability to God in a virtuous manner is distinct from
mere conformity to the social norms of one’s religious group. Rather, people who
welcome accountability to God seek to discern God’s will with wisdom in order
to prosper and better understand their purpose in life. Many people develop this
type of accountability through prayer and devotion, where they seek God’s guid-
ance and confess when they do not live in accordance with the expectations of
their religious faith (Bradshaw etal., 2008; Ellison, Bradshaw, etal., 2014; Elli-
son, Schieman, etal., 2014; Masters & Spielmans, 2007). In essence, religious
individuals (and those who broadly believe in a higher power) are often moti-
vated to think and act in ways that they believe are right in light of their religious
faith—i.e., with theistic or transcendent accountability.
Accountability to God as a virtue has not been explicitly acknowledged in the
religion and health literature, but the potential value of this concept is implied in
research showing that religious norms and expectations have consequences for
PWB (Mannheimer & Hill, 2015). For example, religious norms such as honor-
ing others, preventing and rectifying injustices in the world, and caring for one’s
body (through dietary practices and avoidance of substances) become norms pre-
cisely because an authoritative higher power is believed to have established them
(Ellison etal., 2008; Levin, 2010; VanderWeele etal., 2017a, 2017b; Witvliet,
2020). Fundamental practices—like prayer and meditation—are also grounded
in acknowledgment of a transcendent authority to whom one is accountable
(Boda, 2006; Breslin & Lewis, 2008; Masters & Spielmans, 2007). Authority
implies accountability, and religious practices and beliefs may shape PWB in part
because behaving in accordance with strongly held beliefs is a correlate of well-
being (Evans, 2018; Greenfield & Marks, 2007; Lee etal., 2017).
While preliminary evidence has been presented on potential links between
accountability to God and PWB (Witvliet etal., 2019a), no peer-reviewed stud-
ies have been published to date. Therefore, this study aims to conceptually and
empirically advance research in this area by developing a theoretical framework
in which perceptions of accountability to God are likely to be associated with
PWB. It also evaluates prayer as a moderator of this relationship, taking advan-
tage of data from the 2017 Values and Beliefs of the American Public Survey
(VBAPS), also known as the Baylor Religion Survey. Many of the measures in
these data are not available in other national surveys, so the associations between
accountability to God and diverse indicators of PWB will be examined for the

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first time. The study will conclude with a discussion of the results and sugges-
tions for future research.
Background
Accountability
Conceptualizations of accountability vary widely, with most placing emphasis on
“holding others accountable” rather than on welcoming or embracing accountabil-
ity to God or others (Evans, 2018, 2019; Witvliet etal., 2019a). For example, some
scholars have defined accountability as a “perceived expectation that one’s decisions
or actions will be evaluated by a salient audience and that rewards or sanctions are
believed to be contingent on this expected evaluation (Hall & Ferris, 2011: 134).”
Inherent in accountability to others is the idea that individuals answer to some
agent (or agents) with standing to evaluate them and provide feedback (Witvliet
etal., 2019a, 2019b), as well as dispense rewards for appropriate behavior and pun-
ishments for inappropriate actions (Frink & Klimoski, 1998; Hall & Ferris, 2011;
Lerner & Tetlock, 1999; Stenning, 1995). Humans are social creatures that form
hierarchies and establish structured relationships through the use of power and reci-
procity, so accountability is pervasive in the human experience (Hall etal., 2017),
emerging in religious as well as civic, work, education, and family contexts.
Accountability is sometimes seen as involuntary, undesirable, and punitive, such
as when someone is held accountable via judgment or punishment for an infraction
(Royle & Hall, 2012; Stenning, 1995). However, accountability is also characterized
by a voluntary willingness to fulfill one’s responsibilities in relationships (Evans,
2018, 2019; Frink & Klimoski, 1998; Hall etal., 2017; Tetlock, 1985, 1992). When
embraced, accountability views obligations to others (including God or a higher
power) as desirable, beneficial, and important for personal growth and maturity.
This idea might be confused with responsibility (i.e., being a responsible person),
but responsibility can be construed as a purely individual property in managing
one’s own private affairs. In contrast, the view of accountability being developed
here is necessarily relational in nature (Evans, 2019; Lerner & Tetlock, 1999; Royle
& Hall, 2012; Witvliet etal., 2019a, 2019b).
Accountability asaVirtue
Evans (2018) recently introduced a framework for accountability as a virtue (i.e.,
good, moral, or righteous behavior) where he identified three types: secular account-
ability, metaphysical accountability, and theistic accountability. As he explained,
the first two are rooted in non-religious and philosophical orientations that empha-
size human obligations and duties in the workings of a just and harmonious society
(Balderson & Sharpe, 2005; Engelhardt, 2011; Kurtz, 2010). Theistic accountabil-
ity, the focus of this study, frames moral responsibility among religious individuals
in relationship to God (Ogland & Bartkowski, 2014; Stroope, 2011). The Abrahamic

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religions, in particular, generally hold that God created people with the intent that
they would have close relationships with God, other people, and the world, and that
these would involve accountability (Layman, 2014). Individuals from these faiths
tend to see themselves as living before God, and believe that they are accountable
for living in accordance with moral laws. Moreover, many see themselves (to at least
some degree) in a relationship with God (Bonab etal., 2013; Bradshaw etal., 2010;
Froese & Bader, 2010; Kirkpatrick, 2005), so accountability takes on a personal and
relational dimension. The virtue, therefore, is a kind of welcoming or embracing of
God’s claim rather than a resistance to it. As Evans (2018) noted, the Hebrew Bible
speaks of this when it says: “the fear of the Lord is the beginning of wisdom.” This
is not meant to inspire mere fear of God, as if that would be a good end worthy
of pursuit. Rather, it suggests that wisdom is found when one is properly oriented
toward God as a deserving object of accountability for how one lives.
Accountability to God as a virtue is characterized by answerability to God, wel-
coming the moral implications of faith on a voluntary basis, and embracing faith and
religion as gifts and resources (Ano & Vasconcelles, 2005; Iannaccone, 1994; Parga-
ment, 1997; Stark & Finke, 2000). God has the necessary authority as the author of
one’s life to receive prayer, confession, and sacrifice (Bradshaw etal., 2008; Ellison,
Bradshaw, etal., 2014; Ellison, Schieman, etal., 2014; Masters & Spielmans, 2007),
and God directs individuals toward various ends, behaviors, and aspirations that
are viewed as worthy. The competence of God—who is perceived as omniscient,
omnipresent, and omnipotent—is generally acknowledged, and perceived feedback
from God through prayer, meditation, and the reading of sacred texts is both valued
and desired (Kent & Pieper, 2019). God serves as a primary (though not uncon-
tested) authority in the lives of many religious individuals, in part because God
is understood as a loving parent figure (Bradshaw & Kent, 2018; Bradshaw etal.,
2010; Luhrmann, 2012; Moltmann, 2010). Many believers also report experiencing
a close, intimate relationship with God (often characterized as a secure attachment
to God in the attachment theory literature), which is consistent with the relational
nature of accountability as a virtue (Cicirelli, 2004; Ellison, Bradshaw, etal., 2014;
Ellison, Schieman, etal., 2014; Leman etal., 2018; Silton etal., 2014; Stark, 2017;
Witvliet etal., 2019a, 2019b).
Differentiating Accountability andAttachment
It is important to note that there are obvious similarities between the concepts
of attachment to God (as developed from attachment theory more broadly) and
accountability to God (which has roots in moral philosophy). There is a relational
aspect to both concepts, which explains why these variables are likely to exhibit sim-
ilar relationships with other variables. But, there are important differences as well.
On the one hand, attachment concerns a feeling of presence (i.e., a closeness or dis-
tance from a perceived divine being). On the other hand, accountability necessarily
entails a behavioral component about what is expected concerning certain actions.
Attachment to God is also about proximity and is psychologically diffuse, whereas
accountability is about expectation and is cognitively specific. Further, attachment

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theory focuses on different styles of socio-emotional bonds (i.e., avoidant, anxious)
that develop between individuals and God. These styles are part of the attachment
system and are characterized by differing degrees of proximity-seeking, safe haven,
and secure base behaviors that tend to arise during stressful times when help and
support are needed (Bradshaw & Kent, 2018; Kirkpatrick, 2005). Accountability to
God, in contrast, is better conceptualized as a virtue or a voluntary endorsement
of a set of behavioral or moral standards than a socio-emotional bond linked with
responses to distress (Evans, 2018, 2019).
The Current Study andHypotheses
Study Goals
As previously discussed, a growing literature has linked multiple aspects of religious
life with PWB (AbdAleati etal., 2016; Koenig etal., 2012). Accountability is often
implicit, with studies assuming that religious commitments, beliefs, and practices
are grounded in tacit acknowledgements of accountability to God and/or core reli-
gious beliefs (Greenfield & Marks, 2007; Iannaccone, 1994; Kent & Henderson,
2017; Masters & Spielmans, 2007; Whittington & Scher, 2010). Following this, the
first goal of the current study will be to identify and examine a measure (using exist-
ing survey data) that aligns with perceived accountability to God as a virtue. To
determine whether this indicator of accountability is associated with PWB, the sec-
ond goal will be to examine its relationships with happiness, a sense of mattering to
others, dignity, and meaning and purpose in life. Linking accountability to God with
PWB will lend credibility to the argument that it is a beneficial virtue that promotes
desirable outcomes.
Rationale: Hypothesis 1
Why should we expect perceptions of accountability to God tobe associated with
PWB? A primary reason is that humans are fundamentally social creatures (Flynn,
2008), so psychological health is bound up in positive and constructive relationships,
not only with other people, but also with God. This is consistent with recent work
by Peteet and colleagues (2021), who proposed that accountability to other people
and to God are likely to play a vital, yet underexamined, role in mental health and
mental health care. One reason for this expectation is that accountability to God ties
directly into concepts such as self-regulation, empathy, morality, and social integra-
tion (Beckford & Richardson, 2007; Peteet etal., 2021; Zell & Baumeister, 2013).
Long ago, Durkheim (2005) identified the deleterious effects of anomie (too little
regulation and integration), and those who express accountability to God may be
more willing to submit tosocial regulation and experience any corresponding ben-
efits in well-being (McCullough & Willoughby, 2009). Further, Christian ecclesiol-
ogy teaches that believers form a community of brothers and sisters with God at the

Journal of Religion and Health
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head, and integration via accountability is likely to be associated with a variety of
benefits, including PWB.
Importantly, these relationships are often considered reciprocal, with humans
being accountable to God, and God showing accountability to people by keep-
ing covenant promises (Layman, 2014). This type of accountability may promote
healthy forms of autonomy since it involves discernment, and is distinct from mere
conformity or servility (see Peteet etal., 2021). In addition, for those involved in
religions that view God as relational, PWB is likely to be associated with harmo-
nious, rather than anxious or dismissive, relationships with God (Bradshaw etal.,
2010; Kent etal., 2021; Leman etal., 2018). As noted above, there is already con-
vincing empirical evidence that a perceived intimate relationship with a loving and
supportive God is linked with several aspects of PWB. Virtuous accountability to
God, then, may promote PWB as well since it entails trust, care, and reciprocity.
Further, Kirkpatrick (2005) has argued that God is the ultimate attachment figure,
and strong associations have been demonstrated with mental health (Ellison, Brad-
shaw, et al., 2014; Kent etal., 2018; Leman etal., 2018). Given the relationality
inherent to both attachment and accountability to God, it is reasonable to anticipate
that people who perceive greater accountability to God will also report better PWB.
This leads to the first hypothesis:
H1 Accountability to God will be positively associated with PWB.
Rationale: Hypothesis 2
Crucially, however, prior empirical evidence suggests that one’s level of engage-
ment with God may moderate the proposed association (Bradshaw & Kent, 2018).
Prayer, notably, is a key component of engaging in a relationship with God, so it
is an important mechanism to examine here. Fundamentally, prayer is an attempt
to initiate or cultivate a relationship with the divine, and it is viewed by many as a
foundational expression of faith common to most global religions (Ladd & McIn-
tosh, 2008; Ladd & Spilka, 2002). Prayer also demonstrates commitment to faith
and may reinforce and strengthen belief systems (Mccullough, 1995). It is likely that
individuals who seek greater virtuous accountability with God are also more likely
to engage in frequent prayer because a close relationship with God is cultivated dur-
ing prayer, where the supplicant seeks help for others and oneself, guidance, forgive-
ness, and restoration, while also expressing gratitude and praise (Ellison & Taylor,
1996; Whittington & Scher, 2010). Those who pray frequently may also be more
likely to view their religious practices and beliefs as meaningful and worthwhile,
and thus establish virtuous, accountable relationships with God.
Moreover, prayer has been linked with various indicators of psychologi-
cal distress and well-being in diverse community and clinical samples (Ai
etal., 2002; Francis & Kaldor, 2002; Fry, 2000; Musick etal., 1998; Nooney
& Woodrum, 2002). It also appears to be associated with a greater sense of
meaning and purpose in life (Ellison, 1991; Levin, 2004). However, it is likely
that prayer works together with additional constructs such as relationship with

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Journal of Religion and Health
God (including accountability) to shape PWB. For example, one of the stud-
ies reviewed above suggests that secure attachment to God has stronger associa-
tions with PWB among those who pray frequently and that the highest levels of
PWB are found among individuals who are both securely attached to God and
pray frequently (Bradshaw & Kent, 2018). A similar process may be at work for
accountability to God. Among those who pray frequently, accountability to God
may have a strong association with PWB because the one who is accountable is
actually engaging with the divine on a regular basis. However, this association
may be weaker among those who do not frequently interact with God through
prayer. This leads to the second hypothesis:
H2 The positive association between accountability to God and PWB will be
stronger among those who pray frequently compared with those who do not.
Four Aspects ofPsychological Well‑Being
To test these hypotheses, this study focuses on four unique and diverse aspects of
PWB: happiness, a sense of mattering to others, dignity, and meaning and pur-
pose in life. Some previous research has been conducted on happiness, a sense
of mattering to others (and self-esteem), and meaning, but not dignity (Brad-
shaw & Kent, 2018; Ellison, Bradshaw, etal., 2014; Ellison, Schieman, et al.,
2014; Krause, 2003; Krause, 2008a, 2008b; Krause & Hayward, 2012; Lewis
& Cruise, 2006; Park, 2005; Schieman etal., 2010; Stark & Maier, 2008). No
research to date has analyzed the relationships between perceptions of account-
ability to God (as conceptualized here) and any of these indicators of PWB.
Based on the research reviewed above, there are several reasons to expect
accountability to God to be associated with each of these measures. Happiness is
strongly shaped by social contexts (Haller & Hadler, 2006) and is therefore likely
to be associated with accountability to God, possibly through self-regulation, social
integration, and self-image mechanisms. Accountability to God is expected to be
associated with the perception that one matters to others in part because account-
ability may be seen as a moral good by the group, and is likely to be rewarded and
reinforced in social contexts (especially religious ones) that promote positive images
of the self (Elliott etal., 2004; Lewis & Taylor, 2009). Dignity may be associated
with accountability to God through an appropriation of religious concepts of the self
in relation to God, or by reinforcement of a sense of dignity through social interac-
tion and integration (Jacobson et al., 2009). Meaning and purpose may be linked
with accountability through a sense that one fits within a larger framework of what
makes life meaningful, including relationships with others (Stavrova & Luhmann,
2016). God is a key source of meaning in many religious worldviews, so when one
is accountable to God (i.e., conforms to God’s notion of meaning), people are likely
to find resonance and well-being, including meaning and purpose in life (Krause &
Hayward, 2012; Park, 2005).

Journal of Religion and Health
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Data andMethods
Data
Data come from the 2017 Values and Beliefs of the American Public Survey
(VBAPS), a pen-and-paper, simple stratified mail survey prioritizing 12 strata in the
US population. Each stratum, based largely on age and race/ethnicity, was adjusted
for non-response in addition to final post-stratification weighting based on the
2015 Current Population Survey (see Froese, 2017 for further information). Many
of the measures employed here are not available in other national surveys, so this
is a unique source of information on religion and PWB. A small number of miss-
ing cases on independent and control variables (roughly 11%) were imputed using
Stata 15 (Acock, 2005). The results are based on five imputed datasets, but they
were comparable when listwise deletion was employed and when additional imputed
datasets were analyzed. Dependent variables were used in the imputation process,
but imputed values on the dependent variables were deleted prior to estimating the
regression models. The two questions used for the key independent variable included
a skip pattern for those stating they do not believe in God, and thus 126 atheists with
missing values were dropped from the analysis. Further, 124 cases on categorical
variables that caused convergence problems during multiple imputation (marital sta-
tus, urban/rural residence, education, denomination, and prayer) were dropped. The
final sample consisted of 1,251 individuals.
Measures
Dependent Variables
Four measures of PWB were examined. Happiness was measured with a single item
similar to those used in previous studies (Andrews & Withey, 2012; Stark & Maier,
2008): “In general, how happy are you with your life as a whole these days?” This
variable was coded 1 = very happy and 0 = pretty happy or not too happy.
A sense of mattering to others was measured with a five-item mean index of the
following questions (Sarı & Karaman, 2018; Schieman & Taylor, 2001): (a) “How
much do you feel other people pay attention to you?” (b) “How much do you feel
others would miss you if you went away?” (c) “How interested are people generally
in what you say?” (d) “How much do other people depend on you?” and (e) “How
important do you feel you are to other people?” Each question was coded 1 = not at
all to 4 = a lot.
Dignity was measured with a mean index of the following three items, developed
for this study (α = 0.711): (a) “I feel that my life lacks dignity (reverse-coded).” (b)
“I have dignity as a person.” and (c) “People generally treat me with dignity.” Each
question was coded 1 = strongly disagree to 4 = strongly agree.
Meaning (and purpose) in life was measured with a mean index of the follow-
ing three items (Heintzelman & King, 2014; Kobau etal., 2010): (a) “I have a good

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Journal of Religion and Health
sense of what makes my life meaningful.” (b) “I have discovered a satisfying life
purpose.” and (c) “My life has no clear purpose (reverse-coded).” Each question was
coded 1 = strongly disagree to 4 = strongly agree.
Key Predictor Variable
As a virtue that may foster psychological well-being, accountability to God involves
being answerable to God, looking to God as a guide for making decisions in life,
embracing the responsibilities of one’s religious faith, and viewing God and religion
as gifts that lead to happy and successful lives (Evans, 2018, 2019; Torrance, 2021).
No searchable national datasets contained scales specifically designed to measure
this newly developed concept, but the 2017 VBAPS contained two items that cap-
tured features thought to characterize individuals who welcome or embrace account-
ability to God in living their lives. These included: (a) the reverse-coded item “I
decide what to do without relying on God.” and (b) “I depend on God for help and
guidance.” These items were used to construct a two-item mean index (α = 0.788).
Each question was coded 1 = strongly disagree to 4 = strongly agree. A five-item
measure that included the following items was also considered: (a) “I decide what
to do without relying on God (reverse-coded).” (b) “I depend on God for help and
guidance.” (c) “When good or bad things happen to me, I see it as part of God’s plan
for me.” (d) “God is directly involved in my affairs.” and (e) “How often do you turn
to your religion or your spiritual beliefs to help you deal with your daily problems?”
This measure had high internal consistency (α = 0.868), but it was determined that
only the first two items truly captured accountability to God instead of alternative
concepts such as God-mediated control and religious coping, so the last three were
excluded. However, the findings were very similar for both measures.
Control Variables
To isolate the associations between accountability to God, prayer, and PWB, con-
trols for demographic, socioeconomic, religious, and political variables were
included in statistical models to ensure that they did not confound the key associ-
ations of interest. These included: age (in years), gender (female = 1), marital sta-
tus (a series of dichotomous variables for never married, divorced/separated, wid-
owed, and cohabiting compared with married), race/ethnicity (Hispanic, Black, and
other race compared with white), urban/rural residence, political orientation (coded
1 = strong Republican to 7 = strong Democrat), education (less than high school,
some college, college degree, and graduate degree compared with high school),
income (1 = $10,000 or less to 7 = $150,000 or more), and self-rated health (1 = fair
or poor and 0 = good or excellent). Three religion control variables were also
included: denominational affiliation (no affiliation, Black Protestant, Jewish, Catho-
lic, mainline Protestant, and other compared with evangelical Protestant) (Dough-
erty etal., 2007; Steensland etal., 2000), religious service attendance (0 = never to
7 = several times a week), and frequency of prayer (never, only on certain occasions,
once a week or less, a few times a week, once a day, and several times a day). In the
analyses below, prayer was collapsed into three dichotomous variables: never (the

Journal of Religion and Health
1 3
reference group), moderate prayer (at least some but a few times a week or less), and
frequent prayer (once a day or more). Prayer was used as both a control and a mod-
erating variable.
Analytic Strategy
Descriptive statistics were initially calculated for all study variables. Bivariate cor-
relations between the key independent and dependent variables were then estimated.
A series of regression models were then fit to the data to examine the associations
between accountability to God and PWB. Happiness was analyzed using binary
logistic regression. Mattering to others, dignity, and meaning were analyzed using
ordinary least squares (OLS) regression.To test for the moderating effects of prayer
on the associations between accountability to God and PWB, interaction (cross-
product) terms were constructed. Accountability to God was zero-centered prior to
the construction of the interaction terms to reduce multicollinearity (Aiken & West,
1991). Prayer consisted of the three dichotomous variables described above.
Results
Table1 shows descriptive statistics for all study variables. Levels of happiness, mat-
tering to others, dignity, and meaning were all relatively high in the sample. The
index tapping accountability to God had a mean of 2.963 on a 1–4 scale. The aver-
age age was 55years, 59% of the sample was female, 71% was white, and a majority
(53%) were married. Religious service attendance had a mean of 3.578 on a scale of
0–7, while about half of the sample reported praying at least once a day.
Table2 shows bivariate correlations for key variables. The correlations between
accountability to God, religious service attendance and frequent prayer (once a day
or more) were 0.580 and 0.556, respectively. The strongest correlation between
accountability to God and PWB was with meaning (r = 0.228), followed by dignity
(r = 0.155), mattering to others (r = 0.129), and happiness (r = 0.056). All were sig-
nificant at p < 0.05 or less.
Table 3 shows the findings from the regression models. Model 1 shows that
accountability to God was positively associated with all four outcomes when no con-
trols were included. When controls for age, gender, marital status, urban/rural, polit-
ical orientation, education, income, and self-rated health were included in Model 2,
these associations remained significant. Model 3 shows the full model, which added
controls for religious denomination, service attendance, and frequency of prayer to
the previous model. Accountability to God had an independent association (net of
all controls) with mattering to others, dignity, and meaning, but not the single-item
indicator of happiness. Appendix1 shows results for the full models including all
control variables. Overall, these results provide broad support for H1.
To test H2, which predicted that these associations would vary across levels
of prayer, interaction terms between accountability to God and prayer were intro-
duced into the full models. As shown in Table4, the findings provide support for

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Journal of Religion and Health
Table 1 Descriptive statistics
Mean/percentage SD Min Max
Very Happy 37.9
Sense of Mattering to Others 3.284 0.551 1 4
Dignity 3.461 0.476 1 4
Meaning 3.259 0.560 1 4
Accountability to God 2.963 0.894 1 4
Age 55.134 16.754 17 98
Female 59.2
Male 40.8
Married 53.3
Never Married 15.6
Separated/Divorced 16.3
Widowed 10.2
Cohabiting 4.6
White 70.6
Hispanic 11.8
Black 11.5
Other Race 6.2
City 24.9
Suburban 31.7
Town 30.9
Rural 12.5
Political Orientation 4.185 1.854 1 7
Less than High School 5.0
High School 14.8
Some College 32.5
College Degree 27.6
Graduate Degree 20.1
Income 4.441 1.681 1 7
Fair or Poor Health 11.6
Religious Service Attendance 3.578 2.490 0 7
Black Protestant 7.2
Jewish 2.2
Catholic 28.1
Mainline Protestant 14.4
Evangelical Protestant 30.5
Other Denomination 7.8
No Denomination 9.9
Never Pray 9.3
Pray Only on Certain Occasions 19.1
Pray Once a Week or Less 6.6
Pray A Few Times a Week 15.1
Pray Once a Day 20.9
Pray Several Times a Day 29.0
n = 1251

Journal of Religion and Health
1 3
this hypothesis for three of the four measures of PWB: mattering to others, dignity,
and meaning. The original prayer variable had six categories, but detailed explora-
tory analyses revealed that it could be collapsed into a three-category variable rep-
resenting never pray (the reference group), moderate prayer (at least some but a few
times a week or less), and frequent prayer (once a day or more). Figure1 shows
graphical depictions of these findings. For Fig.1a, accountability to God correlated
Table 2 Bivariate correlations
n = 1251
1 = Accountability to God; 2 = Religious Service Attendance;
3 = Frequent Prayer; 4 = Happiness; 5 = Sense of Mattering to Oth-
ers; 6 = Dignity; and 7 = Meaning
All correlations are significant at p < 0.05 or less
1234567
1 1.000
2 0.580 1.000
3 0.556 0.463 1.000
4 0.056 0.110 0.096 1.000
5 0.129 0.106 0.120 0.267 1.000
6 0.155 0.115 0.106 0.279 0.382 1.000
7 0.228 0.203 0.213 0.335 0.391 0.546 1.000
Table 3 Parameter estimates from the regression of four psychological well-being outcomes on account-
ability to God and control variables
n = 1251
*= p < 0.05; ** = p < 0.01; *** = p < 0.001
Model 1: No controls
Model 2: Controls for age, gender, marital status, race, urban/rural, political orientation, education,
income, and self-rated health
Model 3: Controls for age, gender, marital status, race, urban/rural, political orientation, education,
income, self-rated health, religious denomination, religious service attendance, and prayer
Appendix1 shows the results for the full models including all control variables
Happiness (odds ratios)
Model 1 Model 2 Model 3
Accountability to God 1.163* 1.234** 1.065
Sense of Mattering to Others (OLS parameter estimates)
Model 1 Model 2 Model 3
Accountability to God 0.087*** 0.092*** 0.068**
Dignity (OLS parameter estimates)
Model 1 Model 2 Model 3
Accountability to God 0.084*** 0.100*** 0.089***
Meaning (OLS parameter estimates)
Model 1 Model 2 Model 3
Accountability to God 0.144*** 0.142*** 0.097***

1 3
Journal of Religion and Health
directly with mattering to others among those who prayed frequently (i.e., at least
once a day). The association was weaker for those who prayed some but less than
daily, and the correlation actually appears to be negative for those who never prayed.
(The latter finding should be interpreted with caution, however, because there were
relatively few individuals in this category.) The findings for dignity and meaning
showed a similar pattern (see Fig.1b and c).
In addition to the main effects of accountability to God on PWB, as well as the
interactions with prayer, the concept of accountability to God may also help us
understand the positive associations between commonly examined aspects of reli-
gious life (e.g., service attendance and prayer) and PWB (Bradshaw & Kent, 2018;
Ellison & Lee, 2010; Froese & Bader, 2007). The cross-sectional data used here are
not ideal for examining this possibility, since multiple waves of data are required
to adequately examine whether accountability to God mediates the associations
between both religious service attendance/prayer and PWB. However, some explora-
tory findings appear to offer preliminary support for this possibility.
As shown in Table5, religious service attendance was positively associated with
all four measures of PWB net of controls for demographic characteristics, SES, self-
rated health, and denomination. When accountability to God was added to the mod-
els, the associations were weaker for all four, and no longer significant for percep-
tions of mattering to others, dignity, and meaning. This suggests that accountability
at least partially explains the effects of attendance on these outcomes. Analyses
using the “paramed” procedure in Stata 15 (Emsley & Liu, 2013) indicated statisti-
cally significant total and indirect (through accountability to God) effects of service
attendance on mattering to others, dignity, and meaning. There were no significant
Table 4 Parameter estimates from the regression of fourpsychological well-being outcomeson account-
ability to God, prayer, control variables, and the interaction between accountability to God and prayer
n = 1251
+ = p < 0.10; * = p < 0.05; ** = p < 0.01; *** = p < 0.001
All models include controls for age, gender, marital status, race, urban/rural, political orientation, educa-
tion, income, self-rated health, religious denomination, and religious service attendance
1. Odds ratios from binary logistic regression
2. OLS regression coefficients
3. Frequency of prayer = only on certain occasions, once a week or less, or a few times as week
4. Frequency of prayer = once a day or more
Happiness1Sense of Matter-
ing to Others2
Dignity2Meaning2
Accountability to God 0.730 −0.108 −0.039 −0.017
Prayer (Ref = Never)
Moderate Prayer31.055 0.205 + 0.126 0.147
Frequent Prayer41.443 0.272* 0.151 0.232 +
Accountability to God x Prayer (Ref = Never)
Accountability to God x Moderate Prayer 1.387 0.162* 0.117 + 0.087
Accountability to God x Frequent Prayer 1.701 0.240*** 0.175* 0.182*

Journal of Religion and Health
1 3
Fig. 1 Interactive effects of accountability to God and prayer on PWB

1 3
Journal of Religion and Health
direct effects of attendance that were not explained by accountability to God. This
process was weaker for happiness, which could mean that the social aspects of
attendance matter more for this aspect of PWB.
The findings for prayer are also interesting. Compared with those who never pray,
daily prayer was associated with higher levels of mattering to others, dignity, and
meaning (but not happiness). When accountability to God was added to the models,
the coefficients were reduced by a substantial amount and were no longer signifi-
cant for all three, suggesting that the associations between prayer and PWB are at
least partially explained by accountability to God. The exploratory findings using
paramed indicated statistically significant total and indirect (through accountability
to God) effects of prayer for all three outcomes. There were no significant direct or
main effects of prayer that were not explained by accountability to God. It is impor-
tant to note that these are simply exploratory, cross-sectional findings that should
not be overstated. They do, however, suggest potentially fruitful avenues for future
research using longitudinal designs that can adequately address issues of causal
order, mediation, and direct/indirect effects.
Table 5 Exploratory analyses of accountability to God as a mechanism linking religious service attend-
ance and prayer with psychological well-being
n = 1251
* = p < 0.05; ** = p < 0.01; *** = p < 0.001
All models include controls for age, gender, marital status, race, urban/rural, political orientation, educa-
tion, income, self-rated health, and religious denomination (attendance and prayer were entered into the
models separately)
1. Odds ratios from binary logistic regression
2. OLS regression coefficients
3. Frequency of prayer = only on certain occasions, once a week or less, or a few times as week
4. Frequency of prayer = once a day or more
Happiness1Sense of Mattering
to Others2
Dignity2Meaning2
Religious Service Attendance 1.087** 0.019** 0.017** 0.029***
Religious Service Attendance with
Control for Accountability to God
1.072* 0.009 0.003 0.013
Prayer (Ref = Never)
Moderate Prayer30.612+ −0.003 0.009 0.044
Frequent Prayer41.138 0.139* 0.128** 0.225***
Prayer with Control for Accountability to God (Ref = Never)
Moderate Prayer30.607+ −0.038 −0.037 −0.043
Frequent Prayer41.090 0.055 0.028 0.086

Journal of Religion and Health
1 3
Discussion
This paper builds on a model of theistic accountability developed by Evans (2018),
where believers are answerable to God and make decisions about living their lives
with reliance on God. Religious individuals routinely embrace the moral obligations
of their faith on a voluntary basis, and many view God and religion as gifts and
resources in their lives (Ano & Vasconcelles, 2005; Ellison & Taylor, 1996; Parga-
ment, 1997). They give accounts of their behavior to God through prayer and con-
fession, since God is granted the requisite authority for receiving them (Bradshaw
etal., 2008; Ellison, Bradshaw, etal., 2014; Ellison, Schieman, etal., 2014; Masters
& Spielmans, 2007). Many believers also report experiencing a close, personal rela-
tionship with God, which is consistent with the relational aspect of accountability as
a virtue developed here (Cicirelli, 2004; Ellison, Bradshaw, etal., 2014; Silton etal.,
2014). In essence, religious individuals and those who broadly believe in a higher
power are often motivated to think and act in ways they believe are right in the eyes
of God and their faith or beliefs—i.e., in an accountable manner.
This theistic accountability concept (Evans, 2018) was linked to an existing data-
set with consideration of the existing literature documenting associations between
religion/spirituality and PWB (AbdAleati et al., 2016; Koenig, 2009), as well as
data linking accountability to other humans with desirable outcomes (Balderson &
Sharpe, 2005; Hall et al., 2017; Peloza etal., 2013; Royle, 2017). It was hypoth-
esized that an index comprised of two items broadly related to accountability to God
would be positively associated with PWB. Using a national stratified sample of US
adults who did not deny the existence of God or a higher power, this prediction was
supported for a sense of mattering to others, dignity, and meaning, but not happi-
ness. Of note, the results for happiness were significant when other religious items
were not included in the models, suggesting that accountability matters, but that it
is entangled with other aspects of religious life. It is also possible that the findings
for happiness were weaker because it was measured with a single item with lim-
ited response categories that contains a lot of measurement error. Further, it may
be that happiness varies more on a daily basis compared with the other outcomes,
and may therefore be more strongly correlated with social and psychological factors
that change quickly from day to day compared with relatively stable characteristics
like accountability to God. It was further hypothesized that these findings would be
stronger among individuals who prayed frequently since prayer is often associated
with intimacy with the divine. This hypothesis received support for mattering to oth-
ers, dignity, and meaning, but not happiness. Overall, these results add to a signifi-
cant body of research linking religious beliefs and behaviors with PWB.
Why develop this construct of welcoming accountability to God as a virtue? A
key reason centers on the possibility that this type of accountability may serve as an
important, underexplored mechanism helping to explicate many of the links between
religion and health. While religious systems and networks can impose external (and
sometimes coercive) pressures on individuals to behave in particular ways, they also
operate through individual yearnings, moral frames, and relational impulses (Evans,
2019). In other words, accountability in the religious realm may function, in part,

1 3
Journal of Religion and Health
through the internalization of righteous obligations for behavior under the disciplin-
ing (and loving) hand of God (Layman, 2014). Not all people experience God in
this way, but many do, and this may at least partially account for the positive asso-
ciations between commonly examined aspects of religious life (e.g., service attend-
ance, prayer, etc.) and PWB (Bradshaw & Kent, 2018; Ellison & Lee, 2010; Fro-
ese & Bader, 2007). The cross-sectional data used here are not ideal for examining
this possibility, but exploratory findings offer preliminary support by showing that
accountability to God at least partially explains the effects of both attendance and
prayer on PWB. These initial findings should not be overstated, but they do suggest
fruitful avenues for future research using longitudinal designs that can adequately
address issues of causal order, mediation, and direct/indirect effects.
These findings contribute to our understanding of the mechanisms linking reli-
gious practices and beliefs with PWB in two additional ways as well. When denomi-
nation, attendance, and prayer were included in the models, the associations between
accountability to God and PWB were attenuated, suggesting that accountability and
these measures are at least somewhat interconnected, and likely work together to
shape PWB. However, accountability also had a unique effect net of these variables
for three of the four outcomes, indicating that it adds explanatory value above and
beyond conventional indicators of religiosity. The moderating role of prayer is also
important here. Accountability to God appears to matter less for well-being when it
is not accompanied by relational engagement behaviors such as prayer, suggesting
that religious virtues, beliefs, and behaviors interact in complex ways to shape PWB.
Study Strengths
This study has several strengths. First, it uses data from a large and recent national
survey of US adults. Second, it examines four different aspects of PWB, including an
analysis of dignity for the first time in a study on religion and health. Third, three of
the measures of PWB analyzed here (happiness, mattering to others, and meaning/
purpose) are consistent with at least some previous research on PWB (e.g., Bradshaw
& Kent, 2018; Ellison, Bradshaw, etal., 2014; Krause, 2002), so comparisons can be
made across studies. And fourth, the concept of accountability as a virtue offers prom-
ise not only for helping us understand the role of religion in shaping PWB, but also for
other areas of study such as prosocial activity, deviant and criminal behavior, worker
productivity, and family relations, among many other outcomes that have been linked
with religious participation (Jang etal., 2018; Kent etal., 2016; Mahoney etal., 2003;
Saroglou etal., 2005).
Study Limitations
Despite the strengths of this study, it also has several limitations. First, this is an explor-
atory, concept-building study of accountability to God as a virtue. Theoretical, concep-
tual, and measurement work on this topic is just beginning, so the measures employed
here were not specifically designed with this idea in mind. For example, one of the

Journal of Religion and Health
1 3
items (“I depend on God for help and guidance”) also captures aspects of religious cop-
ing, but we believe there is a distinction. Most people are “voluntarily” accountable to
God (i.e., the only reason they are accountable is because they buy into a belief system
in which God is worthy of accountability). Any voluntary accountability is going to
come with a concomitant posture of seeking guidance from the source of accountabil-
ity, which the measure displays. In addition, religious coping items are almost always
primed with a question stem asking about how one responds to stressful events. That
question stem is absent here, meaning that the respondents were more likely to answer
in the spirit of what we are seeking to measure: broad help and guidance. Without the
stress question stem, “help” can be interpreted in many different ways, and coping is
only one of them. Further, accountability to God is likely to be relevant and responsive
across contexts, including those in which people recognize their dependence on God
and their need.
A second limitation in this study is our use of a two-item measure to capture a
complex construct like accountability to God. While we tested a five-item measure
(α = 0.868), we elected to report the two-item measure (α = 0.788) since it more ade-
quately conceptualized accountability to God. Using a two-item scale is not ideal, but
alpha coefficients tend to underestimate reliability in two-item scales (Eisinga etal.,
2013), and the results were comparable with both measures. In the future, we hope that
a more robust multi-item measure of accountability to God will be developed.
Third, the data on US adults provide key information about this population, but the
findings may not generalize to other countries that have unique religious contexts. It is
also possible that accountability to God may vary in meaning and in association with
PWB in different racial-ethnic populations, age-groups, and religious traditions (Bier-
man, 2006; Krause, 2008a, 2008b; VanderWeele etal., 2017a, 2017b).
Finally, the findings are cross-sectional, so future research using longitudinal designs
will be needed to address issues of causal order. The implied causal order here, from
religion to PWB, is plausible, but it is also possible that PWB shapes perceptions of
accountability to God. The current data cannot be used to address this question.
Future Research andClinical Implication
Future research should build on the theoretical and empirical models presented
here, as well as develop and validate survey items specifically designed to meas-
ure accountability to God as a virtue. Additional measures of PWB should also be
examined, including forgiveness of oneself and others, life satisfaction, optimism,
and sense of mastery or personal control (Cohen et al., 2006; Ellison, Bradshaw,
et al., 2014; Krause, 2004). Indicators of negative affect such as depression and
anxiety should also be examined, along with physical health, health behaviors, and
even mortality (Krause etal., 2017; Krause & Hayward, 2012; Nonnemaker etal.,
2003; VanderWeele etal., 2017a, 2017b. Scholars might also examine how account-
ability works together with other aspects of religious life, such as denominational
affiliation and service attendance to shape PWB, and as noted above, it is possi-
ble that accountability mediates many of the known associations between religion
and health. Further, mechanisms that might link accountability to PWB should be

1 3
Journal of Religion and Health
examined, such as motivating and engagement emotions like fear, guilt, and hope
(Passyn & Sujan, 2006). Finally, the associations between accountability to God and
PWB should also be examined using data where religious traditions such as Judaism
and Islam are better represented than they are in the current survey (which is largely
Christian), since their belief systems map nicely onto the ideas presented here.
The findings presented here (and research on this topic more broadly) may
contribute to clinical practice as well. Health practitioners who endorse holistic
approaches and are open to discussing religion and spirituality with their patients
and clients may draw on the concept of accountability to promote healing and well-
being among those they serve. This is consistent with mounting research on the
use of religion as a coping mechanism for dealing with stressful conditions and as
a source of meaning in life that enhances well-being (Ano & Vasconcelles, 2005;
Koenig, 2018; Lee etal., 2017; Park, 2005). Further, recent research on the concept
of felt accountability suggests that accountability can be internalized by individuals
and that this may lead to desirable outcomes (Hall etal., 2017; Royle, 2017; Royle
& Hall, 2012). This may be true of accountability to God as well, which means
that developing or promoting this potential resource in individuals may result in
increases in psychological well-being, especially if they embrace the accountability
and view it as desirable and beneficial virtue (Evans, 2018, 2019).
Conclusion
To conclude, this study provided an initial foundation for a model in which indi-
viduals perceive themselves to be accountable to God in a virtuous manner. It
then argued this virtue may serve as a resource that promotes PWB. Results pro-
vide tentative support for this possibility, but much work remains to be done. This
topic offers the promise of bridging sociological, psychological, and philosophical
research on religion and health in ways that shed light on human well-being and
flourishing.
Appendix
See Table6.

Journal of Religion and Health
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Table 6 Full models
n = 1251
+ = p < 0.10; * = p < 0.05; ** = p < 0.01; *** = p < 0.001
1. Odds ratios from binary logistic regression
2. OLS regression coefficients
Happiness1Sense of mattering
to others2
Dignity2Meaning2
Accountability to God 1.065 0.068** 0.089*** 0.097***
Age 0.999 −0.001 0.002 + 0.002
Female (Ref = Male) 0.987 0.047 0.055* −0.001
Marital Status (Ref = Married)
Never Married 0.963 −0.156*** 0.035 −0.177***
Separated/Divorced 0.557*** −0.082 + −0.020 −0.067
Widowed 0.731 −0.150** −0.058 −0.085
Cohabiting 0.828 0.099 0.052 0.023
Race/Ethnicity (Ref = White)
Hispanic 0.897 −0.040 −0.038 −0.053
Black 0.509+ 0.085 0.110 0.126
Other Race 0.866 −0.085 −0.076 −0.054
Urban/Rural (Reference = Urban or City)
Suburban 1.035 0.002 0.017 −0.062
Town 0.953 0.020 −0.022 −0.004
Rural 0.912 −0.078 −0.083+ −0.107*
Political Orientations 0.892*** −0.003 0.018* −0.007
Education (Ref = High School)
Less than High School 1.805 −0.130 0.070 −0.040
Some College 1.598* 0.049 0.138*** 0.124**
College Degree 1.787** 0.066 0.166*** 0.137**
Graduate Degree 1.771* 0.039 0.187*** 0.251***
Income 1.184*** 0.026* 0.040*** 0.023*
Fair or Poor Health (Ref = Good or
Excellent)
0.275*** −0.252*** −0.215*** −0.263***
Religious Service Attendance 1.068+ 0.005 0.003 0.007
Denomination (Ref = Evangelical Protestant)
Black Protestant 1.831 −0.017 −0.125 −0.112
Jewish 0.413 + 0.122 −0.055 0.001
Catholic 0.751 0.025 −0.010 −0.021
Mainline Protestant 1.090 0.046 0.026 0.004
Other Denomination 1.231 0.114 + 0.090 + 0.138*
No Denomination 0.894 0.010 −0.023 −0.038
Prayer (Ref = Never)
Moderate Prayer 0.621+ −0.041 −0.053 −0.004
Frequent Prayer 0.892 0.049 −0.010 0.102

1 3
Journal of Religion and Health
Funding This publication was made possible through the support of a grant from the Templeton Religion
Trust (#0171). The opinions expressed in this publication are those of the authors and do not necessarily
reflect the views of the Templeton Religion Trust. The authors also thank the Institute for Studies of Reli-
gion and Dr. Paul Froese for providing financial support and access to the data.
Declarations
Conflict of interest There are no conflicts of interest. This research is in compliance with ethical standards
for scholarly publishing and with the guidelines outlined by the Journal of Religion and Health.
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