Benefits of Prayer on Depression in Elderly Adults

Benefits of Prayer on Depression in Elderly

Chapter 1: Introduction to the Study

Depression is a growing concern among the elderly population (adults over 65

years old). Prayer and worship have been helpful in supplementing traditional

psychotherapy interventions (Wachholtz & Sambamoorthi, 2011). Williams-Orlando

(2012) noted that healers have always prayed for patients and that prayer was essential for

this healing to occur. In this study, I examined if Christian prayer was beneficial in

reducing symptoms of depression among elderly adults while controlling for amount of

The elderly population is increasing in the United States and in other

industrialized nations throughout the world (Rowland, 2009). The elderly population

(ages 65 years and older) is estimated to represent approximately 20% of the U.S.

population by the year 2030 (U.S. Administration on Aging, 2004). Gerontological (the

study of aging) and palliative (end of life) care are becoming increasingly important as

the population ages. In the later stages of life issues such as illness and the loss of a loved

one can evoke emotional problems.

The elderly frequently experiences a significant decline in physical health as a part

of the aging process. Declining physical health (e.g., hearing loss, vision loss, etc.) of the

elderly often results in a diminished quality of life (Boi, 2012). Chronically physically ill

Belief in the supernatural pervades culture (Pew Research, 2013; Dumais &

Sugarman, 2015). According to Koenig (2008), 93% of Americans believe in God or

some form of a higher power. It has been suggested that 84% of the world’s population

identifies as religious (Pew Research, 2012). Therefore, the tendency to believe in God

and offer worship is part of the common human experience. The quest for some

researchers has been to discover the beneficial effects of religious practices. The focus of

this study was on the effects of prayer in reducing depressive symptoms and improving

the quality of mental health in the elderly population.

Studying religious and spiritual factors among the elderly is relatively new (Steensland

et al., 2000). Spirituality in relationship to patient illness has been explored in fields such

Chatters, & Taylor, 2011; Lukoff, 2014). In recent years both social scientists and health

professionals have increased attention on religion and spirituality (Joshi, Kumari & Jain,

Practicing religion and spirituality has been shown to benefit mental health

(Krause, 2011; Tabak, 2014; Weisman de Mamani et al., 2010). For example, Sun et al.

(2012) demonstrated that practicing faith is effective in reducing depressive symptoms.

Studies have also shown that prayer can be effective in treating depression and has been

associated with lower levels of distress and greater well-being (Maciejewski et al., 2012).

Therefore, religious practices may have also have a therapeutic function secondary to

people connecting to their faith. However, researchers have not explicitly examined the

effects of prayer in reducing depressive symptoms in the elderly across the variables of

ethnicity, gender, religious exercises, and perceptions of prayer.

Many elderly people are actively religious. It has been documented that older

Marche (2006) also demonstrated that religious coping methods such as prayer and

meditation have had a positive effect on the physical, mental, and emotional health of the

Some evidence exists that there is a difference between ethnic groups in the use of

mental illness in the overall population.

Previous research in this field has been primarily focused on the effectiveness of

spiritual practices (prayer, meditation, and worship) in treating depression among various

populations (Krause, 2012b; McCoubrie & Davies, 2006). Wachholtz and Sambamthoori

(2013) considered the effectiveness of spiritual practices within the elderly population.

They discovered that non-Caucasians, females, and people of a lower education level are

more likely to engage in prayer than their counterparts. They also noted that people who

pray are more likely to use other protective behaviors to ensure their health. However,

controlling for ethnicity, gender, and time spent in prayer within the elderly Christian

population. As the population ages, 78 million baby boomers (people born between 1946

effective across multicultural dimensions.

and frequency of prayer. These associations have not been examined by other researchers

using this type of research design, which makes this study unique and addresses a gap in

the literature about these variables. Examining these variables was important so that

researchers can better understand the factors that mitigate the relationship between

Christian prayer and depressive symptoms.

Research Question(s) and Hypotheses

The overall research question was: After controlling for gender, ethnicity, and

time spent in prayer, are there differences on depressive symptoms in the elderly by time

H01: After controlling for ethnicity, prayer does not reduce depressive symptoms

by time (Wave 1 vs. Wave 2).

H11: After controlling for ethnicity, prayer does reduce depressive symptoms by

time (Wave 1 vs. Wave 2).

symptoms by time (Wave 1 vs. Wave 2).

H13: After controlling for frequency of prayer, prayer does reduce depressive

symptoms by time (Wave 1 vs. Wave 2).

It was hypothesized that Christian prayer was related positively to the reduction of

depressive symptoms of the elderly across the variables. Christian prayer was the

primary focus in this study as it was used in the data set. For this study depressive

symptoms were quantified by using eight items from the Center for Epidemiologic

Studies Depression scale (CESD). It is hoped that this study can contribute to the

growing body of data on this topic by focusing on the independent variables of gender,

ethnicity, and time spent in prayer in relation to the dependent variable of depressive

Theoretical Foundation

the ways they can develop their health. SOC has also been described as human mental

construct designed to resolve conflicts and endure stress (Junqing, Khan, Jahn, &

The principles of SOC are comprehensibility, manageability, and meaningfulness

(Cilliers, 2011; Gropp, Geldenhuys & Visser, 2007; Vossler, 2012). Comprehensibility

refers to the concept that events in the universe are ordered, structured, and make sense.

Prayer often implies that a transcendent God can make sense of the universe. Prayer can

offer a framework for understanding the apparent capriciousness of the universe.

Manageability is the extent to which a person feels he or she can survive and cope.

Prayer is a means by which people often use to cope with stressful life events.

Meaningfulness refers to how people understand and create value to the challenges of

Antonovsky (1979) asserted that the external world could be discerned and

independence over circumstance. He outlined strategies necessary for restoring order and

coping with disease causing factors (Griffiths, Ryan, & Foster, 2011; Korotkov, 1998).

Antonovsky also theorized that people can infuse meaning into the experiences of life.

He stressed the importance of social support and lifestyle as two mediating factors in the

religion-health relationship. Having a strong SOC can aid an individual in coping and

The underlying assumption for this study was the belief in a transcendent,

omnipresent, omnipotent, sovereign, and loving God. This is the God described in

orthodox Christianity. It is this religious context that the data set was grounded. Within

the Christian framework, prayer becomes a meaningful practice. In a broad sense religion

is responsible for “shaping people’s worldviews, moral standards, family lives, and

sometimes their politics” (Kelley, 2015, p.1).

Quantitative research was the ideal method used for the topic of this research.

This type of design provided objectivity and generalizability. Quantitative research is a

format in which the researcher reduces the topic into variables and analyzes relationships

between those variables. The quantitative researcher examines a representative sample of

a) currently practice the Christian faith, b) those who used to be Christian but are not

lifetimes. The first wave was collected in 2001 (1,500 participants) and Wave 2 (1,024

participants) was collected in 2004. This survey was based on face-to-face interviews

with older adults aged 66 and over. The sampling frame consisted of individuals from the

Centers for Medicare and Medicaid (CMS) beneficiary list. The final sample consisted of

1,024 participants (63% female, 37% male). Participants’ ages ranged from 67 to 98.

Among the second wave 847 (82%) were Caucasian, and 146 (14%) African American.

Regarding marital status 47% of the participants were currently married, 40% widowed,

8% divorced, 4% never married, and 1% separated. Depressive symptoms were

measured using eight items from the CESD scale (Radloff, 1977). The CESD scale is a

population. The CESD was used to screen for depression in primary care settings (Myers

The scope of this study included the effects of prayer on moderate to severe

depressive symptoms based on the CESD. The study was focused on the elderly

over the age of 65 (Administration on Aging, 2012).

selfreport of depressive symptoms. Another limitation is that this type of research may

not be generalizable to other populations (ethnicity, age, and religious beliefs).

Significance of the Study

The significance of this study was to examine the nature of the relationship

between Christian prayer and depression in the elderly. This study was based on the SOC

theory. Proponents of SOC claim that people’s life orientations will have an impact on

could be translated to practice in psychology. This study may promote positive social

change by emphasizing mental health as opposed to mental illness. In the West

This study may be significant in advancing the notion that prayer is an effective

This study may promote positive social change by reducing the ill effects of

depression in the elderly population. Based upon the results of this research, both

researchers and clinicians could develop psychological interventions that are faith-based

in which a person can achieve empowerment. Because of this study, researchers may

open the door to a more complete partnership between clergy and psychology.

affected by depression. I hope to inspire more research of this kind in the field of

gerontology, which may generate multiple treatment interventions for the elderly.

Summary and Transition

gender, ethnicity, and time spent in prayer. The SOC theory provided the theoretical

foundation of this study.

of information collected (eight items from the CESD scale). This study, together with

other studies of this nature, could generate a series of discussions between clergy,

research psychologists, clinical psychologists, gerontologists, and others about the nature

of collaborative clinical work to achieve mental health in the elderly.

In Chapter 2, the literature review is presented. I selected journal articles that

directly pertained to depression, prayer, the elderly and SOC theory from PsycINFO,

SocIndex, and PsycArticles.

–Charles H. Spurgeon, Prayer: The Proof of Godliness, 1895

This chapter covers the review of literature related to key concepts such as elderly,

65 to 74 years old. The classification of “Old” is given to people between the ages of 74

one in every eight, or 13.3%, of the population is an older American (Administration on

Aging, 2012). By 2050, the United States is projected to experience rapid growth in its

older population (U.S. Census Bureau, 2010).

Older adults often experience a decline of physical health. It has been established

that the declining physical health (e.g., hearing loss, vision loss, etc.) of the elderly results

Although declining health does negatively influence quality of life in the elderly, it has

been noted that a sense of purpose does not necessarily decline in all elderly people

(Pearson, 2013).

al., 2012). It has been shown that the chronically physically ill elderly experience poorer

mental health than their physically healthy equivalent (Fiske, Wetherell, & Gatz, 2009).

Aging brings with it a set of difficulties; declining health and hearing loss in the elderly

can lead to depression (Pronk et al., 2013). A loss of purpose, social withdrawal, and

subsequent feelings of hopelessness can lead to increased suicidality and magnify the

Depression has various causes and various treatments. Sun (2012) noted that

people with depression experience benefits of attending religious services. Prayer has

Sambamoorthi, 2011). Wachholtz and Sambamoorthi (2011) noted that prayer is used as

a complimentary form of therapy in the treatment of depression. Moreover, Williams,

Participation in religious activity has been found to aid in the treatment of

and Joe (2013) noted the benefit of weekly religious service attendance in reducing

suicide, which is a common feature of MDD. In their study, a total of 6,082 face-to-face

interviews were conducted with persons aged 18 or older (3,570 African Americans, 891

non-Hispanic Whites, and 1,621 Blacks of Caribbean descent). Suicidality was assessed

by using the section of the World Mental Health Composite International Diagnostic

Interview, which includes a series of questions about lifetime suicidal behaviors.

“Other than for weddings or funerals, have you attended services at a church or other

place of worship since you were 18 years old?’” and ‘”How often do you usually attend

religious services?” The researchers compared interview results to church attendance.

Chatters et al. concluded that “respondents who attended religious services at least once

per week were the least likely to report suicidal ideations” (p. 346).

In this study, I examined the effects of prayer on depression in the elderly

population from a selected data set. The data set exclusively examined the Christian

religion. Therefore, the religion in this study was traditional, orthodox Christianity also

Religious practice can be a coping mechanism for older adults. Galek & Porter

religion and mental health. However, “there is only a small body of literature on the

relationship between religiosity and spirituality with the use of mental health services in

the elderly population” (Ng et al., 2011, p.143). Therapists and social scientists have

explored the ways that religion can influence emotional well-being (Koenig, 2007). In

this study, I focused on the influence of Christian prayer on depression in the elderly.

depression, prayer, and the elderly. I used PsycINFO, SocIndex, and PsycArticles, using

the terms depression, prayer, elderly, and spirituality to get results. The literature

included in the review had an emphasis on the last 5 years, and oldest publication date for

pertinent literature was from 1930. The theoretical perspective I used in this study was

the SOC theory (Antonovsky et al., 1971).

Theoretical Foundation

Sense of Coherence

SOC theory was developed by Antonovsky under the salutogenic paradigm in the

1971). He introduced the SOC theory, claiming that peoples’ life orientations will have

an impact on health (Eriksson & Lindström, 2007). Antonovsky (1992) noted that “rather

than measuring a sense of control, I believe it is more to the point to see such people as

having a sense of proactive responsibility” (p. 1024). Antonovsky (1979) explained that

people cannot be grouped into either physically ill or healthy dichotomies; everyone has a

level of health which can be measured on a continuum. Antonovsky (1996) also asked,

“Can it be contended that strengthening the SOC of people would be a major contributor

to their move toward health?” (p. 16).

life from illness to bereavement. Manageability is another component of SOC. This

refers to the confidence that a person can cope with demands with the help of resources

controlled by self and others (Cilliers, 2011). Those who have a strong sense of

component of SOC. It is the belief that the demands are a challenge instead of a burden

(Cilliers, 2011; Vossler, 2012). Meaningfulness has been described as the degree to

that patients with high SOC scores have lower admission rates to hospitals have a greater

level of functioning and are more likely to belief that their medical treatment are effect.

In this section, I highlight how SOC and meaning related to religion and coping with

older age. Also included is a description of the mechanisms of social support and health

behavior. Feigin and Sapir (2005) found that SOC has a great deal of empirical evidence

Religion has been theorized to affect health through the construction of meaning

and the improvement of SOC. Bonelli, Dew, Koenig, Rosmarin, and Vasegh (2012)

stressful situations. According to Antonovsky’s theory, SOC refers to an overall sense of

meaning, coherence, and management of life (Antonovsky, 1979). This has been linked

to several health outcomes. The SOC theory mimics the importance of meaning in

better overall health, and religious meaning (beliefs concerning the cause, nature, and

purpose of self and the universe) is predictive of well-being. Religion may be important

for the elderly in constructing meaning from suffering. Religion can provide insight to

life, define purpose, and increase life satisfaction (Krause, 2003). Krause (2003) also

demonstrated that meaning in life and optimism were tied to the religious faith of older

adults. Hicks and King (2008) demonstrated that meaning in life was closely linked to

religious belief. It has also been noted that the pursuit for meaning is central for people

who are high in religious commitment (Hicks & King, 2008)

Another area pertaining to SOC theory is social support. Levin (1994) noted that

involvement in religious services promotes social support, a sense of belonging and

researchers suggest that people who feel more grateful to God tend to enjoy better

physical and mental health (Rosmarin et al., 2011). Religious service attendance,

(2012) noted that attachment to God reduced the effects of stress. According to Dein and

physical and psychological health has been somewhat mixed (Hwang et al., 2011). In

addition, much of the research on religion and or spirituality in connection to health has

also concentrated mostly on Jewish and Christian faiths, with little attention devoted to

adherents of minority religions (Hwang et al., 2011). While further study regarding the

benefits of other religions could be beneficial the focus of this study is on the Christian

perspective. The benefits of religion on mediating the symptoms of mental illness have

been noted in previous paragraphs. Furthermore, spiritual practices have shown to

improve quality of life (Weisman de Mamani et al., 2010). There are also positive effects

of prayer on MDD.

Major Depressive Disorder

Depression is a real concern. MDD is a common ailment and is the leading cause

2013). MDD is one of the most common psychiatric diseases with an estimated lifetime

morbid risk for MDD of 29.9% (Kessler, 2012). Approximately 6.3% of adults in the

Sorenson, 2013). The diagnosis of depression has increased over time in general (Marcus

diagnosis of MDD (Rubio-Valera et al, 2015). Depression is associated with higher rates

of morbidity, mortality, and medical costs (Davydow et al., 2011; Pearce et al., 2015).

Nevertheless, depression affects all ages, races, and SES groups.

Depression is common among the elderly (Ingersoll-Dayton, Torges & Krause,

Astonishingly, according to one study, the rate of depression among older women was

reported to be 40% and among men was reported to be 38% (Murphy et al., 2015).

Depression, a source of emotional suffering, is a common malady among the

one study and noted that depressive disorders are one of the leading causes of years lived

experience depression (Centers for Disease Control, 2012). The diagnosis and treatment

of depression has increased over time in general (Marcus & Olfson, 2010). It has been

noted that approximately one-third of people over the age of 65 years report loneliness,

with even higher rates among those aged over 85 (Hauge & Kirkevold, 2012). In home

health care, estimates of 27.5% for significant depressive symptoms were found (Gellis,

2006). According to Spangenberg et al. (2011) elderly women who live alone, are

widowed, and less educated tend to have the greatest likelihood of experiencing

depression. Fiske, Wetherell & Gatz (2009) noted that half or more of geriatric major

depression represents a new condition arising in old age. Morimoto, Kanellopoulos, &

symptoms and impaired cognition doubles every five years after the age of 70” (p. 138).

To be diagnosed with MDD a set of symptoms must be present. The Diagnostic

and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric

MDD are markedly diminished interest or pleasure in all, or almost all, activities most of

the day, nearly every day, significant weight loss when not dieting or weight gain (e.g., a

change of more than 5 percent of body weight in a month), psychomotor disturbance

(agitation or retardation) nearly every day, or decrease or increase in appetite nearly every

day (American Psychiatric Association, 2013). Sleep disturbance (insomnia or

hypersomnia nearly every day), fatigue or loss of energy nearly every day are other

symptoms of MDD (American Psychiatric Association, 2013). Feelings of worthlessness

or excessive or inappropriate guilt (which may be delusional) nearly every day (not

merely self-reproach or guilt about being sick), diminished ability to think or concentrate,

last for two weeks (Vitiello, 2009). Also, the symptoms are not due to the direct

physiological effects of a substance or a general medical condition (American Psychiatric

Association, 2013).

Stress can also lead to depression (Hammen, 2005). According to Simon (2013)

“individuals with a high level of work-related stress are more than twice as likely to

2011).

emotional and physical response to death (Ringold, 2005). Grief includes a wide range of

emotions, including sadness, anger, guilt, and despair. Typically, the symptoms of grief

diminish as time passes and with support from family and friends. However, MDD

According to cognitive behavioral theory the cause of MDD is due to faulty

thinking patterns (Depression, n.d.t; Traeger, 2013). Some of the faulty thinking patterns

are the result of magnifying the worst in situations (Insel, 2015). A person can have a

negative mental view regarding self, the world, and the future. Benjamin et al. (2014)

noted that the basic premise of CBT is irrational thinking, which leads to maladaptive

feelings and behavior.

interpersonal behaviors cause other people to reject him or her (Nemade, 2007). This

sense of rejection in turn leads to depression. Therefore, IPT relies on social interplay to

create the symptoms of depression.

According to the psychodynamic approach, MDD is caused by anger converted

into self-hatred or “anger turned inward” (Nemade, 2007, para. 4). For example, a child

The treatment of depression is varied (Kalibatseva & Leong, 2014). There is an

increasing requirement for mental health workers to be trained to deliver evidence-based

psychotherapies for the treatment of depression (Crowe et al., 2012). In the following

paragraphs, CBT, IPT, DBT, ECT, and psychopharmacological interventions will be

briefly discussed.

The most common psychotherapy for the treatment of depression is CBT, which

was developed by Beck (Beck et al., 1987; Bruijniks et al., 2015; Pössel & Black, 2014).

Scogin, 1998; Pössel, & Black, 2014; Snowden, Steinman & Frederick, 2008.; Traeger,

2013; Vitiello, 2009). CBT involves both homework assignments and regular

Lopez & Basco, 2015; Oestergaard &, Møldrup, 2011; Rucci et al., 2011; Serfaty, et al,

2009; Vitiello, 2009). CBT has shown to be particularly effective in treating depression

in the elderly population (Krishna et al., 2013). CBT can be employed alone or in

combination with medication (Vitiello, 2009). CBT has found to be effective in treating

depression and, with modified CBT-I, insomnia (Ashworth, et al, 2015). Scogin et al.

(2013) demonstrated that the CBT is particularly effective in treating depression among

the elderly.

with the onset of depressive symptoms (Raue & Areán, 2015). IPT unlike CBT focuses

primarily on interpersonal conflicts.

Like CBT, IPT is focused on what is happening in the present (Markowitz &

Weissman, 2004). IPT usually involves up to 20 weekly sessions, each lasting

approximately one hour (Swartz, 2015). IPT focuses on a person’s social and

2011). DBT is a psychological treatment method that combines CBT with two additional

techniques: dialectics and mindfulness. The dialectics rely on discussion or dialog to

explore and resolve issues (Freedman & Duckworth, 2013). Mindfulness is used to

encourage individuals to become more aware of and present in the moment so that

concerns about the future or rumination about the past do not interfere with their ability to

enjoy life (Jennings & Apsche, 2014). DBT was developed as a technique for patients

suffering from borderline personality disorder (BPD), and has subsequently been shown

to be effective for treating patients with a variety of symptoms and behaviors associated

with mood disorders (Gunderson, 2011).

While open to debate, electroconvulsive therapy (ECT) is considered one of the

most effective yet stigmatized treatments for depression and has been recommended as a

McLoughlin, 2012; Kellner et al., 2010; Loo et al., 2012). Oltedal et al. (2015) stated:

“The idea that convulsions could treat mental illness can be traced to the 16th century,

suffering from MDD is a class of medications called selective serotonin reuptake

inhibitors or SSRIs (Altamura, et al., 2013; Miller, et al., 2014; Zhang, et al., 2015;

Zhang, Becker, & Koesters, 2014). Selective serotonin reuptake inhibitors (SSRIs) work

by focusing on the neurotransmission systems (Zhang et al., 2015). Zhang et al. (2015)

noted that after applying SSRI treatment (paroxetine, 20 mg/d) for 12 weeks, depressive

symptoms had greatly decreased. SSRIs have become the first-line antidepressant drug

treatment of depression and replaced tricyclic antidepressants (TCA) and monoamine

oxidase inhibitors (MAOI) due to fewer side effects (Zhang, Becker, & Koesters, 2014).

Miller et al. (2014) found that adults aged 65 years or older were found to have lower

(p.1221). Marche (2006) also commented: “religious coping methods have also been

reported to have a positive effect on the physical, mental, and emotional health of

“can have psychological, physical, spiritual, and emotional benefit” (p. 59).

Siverman, 2007). Harvey and Silverman (2007) conducted in-depth interviews of 88

people (47 African American and 41 Caucasian) men and women aged 65 years and older

larger spiritual force (76.7% compared to 46.4% for Caucasians), and looking to God for

strength, support, and guidance (93.6% compared to 78.1% for Caucasians). However, it

is important to note that spirituality was used as a coping strategy in a variety of ways

(e.g., prayer, Bible study, and worship service attendance) to effectively deal with life’s

daily challenges (Harvey & Silverman, 2007).

Williams et al. (2012) studied 500 elderly African American participants. The

focus of the study was on the connection between the spiritual and religious affiliation on

quality of life. They discovered that: (a) strong identification with religious institutions,

high levels of attendance and participation in religious activities, (b) perceived support

from fellow church members, and (c) strong reliance on spirituality and their sense of

Sun et al. (2012) examined the religious behavior of 1,000 community-dwelling

participant’s ages 65 years and older (median age 75 years) in a longitudinal study

control variables included depressive symptoms, sociodemographic factors (gender,

marital status, & education), health (number of sick days in bed, physical limitations, and

cognitive status.), and perceived social support (availability of, sensitivity to, interest in,

possible treatment for depression could be patient-centered interventions that increase

intrinsic religiously.

sample of older adults (N = 164; mean age 81.9 years) living in a continuing care

retirement community. The scores from the Daily Spiritual Experiences Scale were

analyzed for changes over time to determine the relationship between chronic illness

impact and markers of psychological well-being (as measured by the Geriatric

Depression and Life Satisfaction scales). Using a Mixed ANOVA and t tests showed a

depression and anxiety symptoms in the elderly. Rushing et al. (2013) noted that among

people with MDD that attended church frequently had less current suicidal ideation and

that this relationship was to some extent mediated by perceived social support. It has been

and spiritual practices incorporated into therapy for the treatment of depression and

anxiety.

The underlying philosophical framework for this study is SOC. Adherents to

important when conducting a study that compares the two populations. Understanding

gender differences is also important when considering the effectiveness of prayer. It is

the elderly population. It was hoped that this study would fill the gap in the current

important so that future researchers can better understand the factors that influence the

effectiveness of prayer. Furthermore, previous research in this field has been primarily

This chapter includes the design and rationale of the study, the methodology, a review of

the archival data, and the variables involved in the study.

is often used when working with larger samples to reduce bias and apply the findings to

the general population. In addition, during this quasi-experimental longitudinal study, I

examined the effectiveness of prayer in reducing depressive symptoms after controlling

for ethnicity, and gender, along with time spent in prayer. Repeated measures analysis of

covariance (mixed ANOVA) was used to analyze the differences between group means

The purpose of this study was to determine whether prayer was effective in

reducing depressive symptoms. I used a quantitative design, which was ideal because of

survey with the 2004 survey.

for the effects of gender, ethnicity, and time spent in prayer does the use of (Christian)

prayer reduce depressive symptoms?

The data set included data collected in two waves. The first wave occurred in

2001 and the second occurred in 2004. The purpose of the survey was to collect data on

the various religious groups within the elderly population in the United States. The

survey included demographic variables such as age, ethnicity, gender, years of formal

education, and yearly income. It also included the participants perception related to

physical health. Mental health symptoms, particularly depressive symptoms were

The overall research question was: After controlling for gender, ethnicity, and

time spent in prayer are there differences on depressive symptoms in the elderly by time

by time (Wave 1 vs. Wave 2).

time (Wave 1 vs. Wave 2).

symptoms by time (Wave 1 vs. Wave 2).

Methodology

This study was based on a quantitative longitudinal research study with one independent

Population

In this study, I used a data set. The data set was entitled “Religion, Aging, and

Health Survey, 2001, 2004” (Krause, 2006). The samples were taken from Wave 1 and

Wave 2 interviews. The sample consisted of 1,500 elderly adults living in the contingent

U.S.

Eligibility List. The list contains the name, address, sex, and race of essentially every

draw the sample. First, researchers drew a 5% sample of names from their master file.

These names were selected with a simple random sampling procedure to include

individuals who were 65 years of age or older. In the second stage of the sampling

procedure, the 5% file was split into two subfiles: one containing older Caucasians and

one containing older African Americans. Each file was sorted by county, and then zip

code within each county. Then, in the third stage, an nth interval was calculated for each

subfile based on the total number of eligible records. Following a random start, 75 nth

selections were made in each subfile. In the fourth phase of the sampling strategy,

primary sampling units (PSUs) were formed by selecting approximately 25 names above

persons within each PSU were recruited for an interview with the goal of obtaining

approximately 10 cases per PSU. The final sample consisted of 748 older Caucasians and

752 older African Americans (1,500 participants).

Wave 2 was collected in 2004. This wave consisted of re-interviews with 1,024 of

the original participants. For the Wave 2 interview, 75 refused to participate, 112 could

not be located, 70 were too ill to participate, 11 moved to a nursing home, and 208 were

religious preference.

The data in this study were derived by comparing both waves. The data included

the religious practices, perceptions of religious practices, self-rated health, depression,

and psychological well-being in a sample of older African Americans and Caucasians (65

years and older) within the United States. The sampling frame consists of individuals

from the CMS beneficiary list. The questions addressed religious status and activities

among people who are currently active in the Christian faith, former Christians, and those

who have never participated in religion.

with the ethics of data collection in research. I had no ability to observe and verify the

data collection process.

2. The data collection phase can be influenced by tendencies of the examiners when

collecting the data. The interviewers who contacted the subjects and conducted the

interviews were subjected to human error and bias.

verified by. The coding process is subject to human error.

5. The degree of depressive symptoms was measured by using eight of the 20 items

from the CESD scale. Eight items on depression may not exhaustively measure

6. The questions related to prayer and other religious activities are not exhaustive.

adequately.

7. The examinee’s perception of the effectiveness of prayer in treating depression is

a threat to internal validity. The religious interventions may not have a significant

positive influence on the effects of depression.

who collected the data selected subjects who were from the Centers for Medicare and

Medicaid (CMS) beneficiary list. This sample relates specifically to people who

participate in the social pay source insurance programs.

9. The archival data is not subject to a control group. The lack of a control group

means that any detected change over time cannot be attributable solely to effects of

prayer on depressive activity.

appendices of this discussion. Because the current study used archival data I did not have

access the consent forms that were used in the data collection process. Consistent with

the principles of the APA Ethical Principles of Psychologists and Code of Conduct

(American Psychological Association, 2002), participants in this archival study were

protected by being allowed to give informed consent before voluntarily participating, and

being able to withdraw at any time. Responses were not linked to individual respondents,

assuring anonymity, results were only presented in the aggregate and the data were kept

confidential. No information disseminated from this study contained personally

identifying information. The electronic data will be stored on a secure hard drive for at

least seven years. After this time, the data will be destroyed unless it is needed for

aging program within ICPSR.

Summary

combination, might be related to the depressive symptoms among the elderly. A repeated

measures analysis of covariance design examined the same subjects across time. This

Introduction

hypotheses were:

by time (Wave 1 vs. Wave 2).

time (Wave 1 vs. Wave 2).

by time (Wave 1 vs. Wave 2).

symptoms by time (Wave 1 vs. Wave 2).

This chapter contains the findings of the statistical analyses conducted to address

the research question and hypotheses. First, details about the data collection and

hypothesis will be described. This chapter concludes with a summary of the findings.

Data Collection

participants in the data set indicated that they prayed several times a day (n = 477, 46.6%)

and 4.8% of participants (n = 49) indicated that they never prayed.

Table 1

African-American 173 16.9

Asian or Pacific Islander 1 0.1

Other Race

3

0.3

Gender

Male

379

37.0

Female

645

63.0

Marital Status Currently

married

705

47.0

Decline to answer

3

0.3

Not sure 9 0.9

Several times a day 477 46.6

Once a day 315 30.8

A few times a week 84 8.2

Once a week 20 2.0

A few times a month 26 2.5

Once a month 12 1.2

Less than once a month 29 2.8

Never 49 4.8

Table 2

Descriptive Statistics for Depression Scores

Variable Mean Std. Deviation

Depression (Wave 1)

Depression (Wave 2) 1.46 0.60

To address the research question and hypotheses, a series of repeated-measures

mixed ANOVAs were conducted. The between-subjects’ independent variable in this

analysis was depression (measured at Wave 1 and Wave 2). The covariates in this

analysis were ethnicity, gender, and frequency of prayer. Ethnicity was coded such that

White = 1, Black = 2, African-American = 3, Asian or Pacific Islander = 4, Native

American or Alaskan native = 5, mixed racial background = 6, and other race = 7.

Gender was coded such that male = 1 and female = 2. Frequency of prayer was coded

such that “several times a day” = 1, “once a day” = 2, “a few times a week” = 3, “once a

week” = 4, “a few times a month” = 5, “once a month” = 6, “less than once a month” = 7,

and “never” = 8. A separate mixed ANOVA was conducted for each covariate.

Hypothesis 1

Prior to interpreting the mixed ANOVA for ethnicity, the assumptions of

were not normally distributed. However, the mixed ANOVA is considered robust against

deviations from normality when the sample size is large (Stevens, 2009), so the analysis

was continued. Homogeneity of variance and covariance means that the variance and

covariance matrices between groups are similar. This was tested using Levene’s test and

Box’s M test. Levene’s test is used to check that variances are equal for all samples when

the data come from a non-normal distribution. Box’s M statistic is used to test for

homogeneity of covariance matrices. The results of these tests were not significant (all

pvalues > .05), indicating that these assumptions were met.

main effect of use of prayer was not significant, F(1, 1006) = 0.09, p = .769, indicating

that there was no overall difference in depression between people who prayed and people

who did not pray after controlling for ethnicity. The main effect of ethnicity was not

significant, F(1, 1006) = 1.31, p = .252, indicating that there was no overall difference in

1.40, p = .237, indicating that there was no overall change in depression from Wave 1 to

Wave 2 after controlling for ethnicity. The interaction between use of prayer and time

Within-Subjects Effects

Time

0.36

1

0.36

1.40

Time x Use of Prayer 0.41 1 0.41 1.59 .208 0.00

Error

261.94

6

0.26

Between-Subjects

Effects

Use of Prayer

0.04

1

0.04

0.09

Error 450.26 100 0.45

homogeneity of variance, and homogeneity of covariance were tested. Normality was

tested using Shapiro-Wilk tests. The results of the test for depression at both Wave 1 and

Wave 2 were significant (p-values < .001), indicating that the dependent variables were

not normally distributed. However, mixed ANOVA is considered robust against

deviations from normality when the sample size is large (Stevens, 2009), so the analysis

was continued. Homogeneity of variance and covariance was tested using Levene’s test

and Box’s M test. The results of these tests were not significant (all p-values > .05),

indicating that these assumptions were met.

The results of the mixed ANOVA for gender are presented in Table 4. The main

effect of use of prayer was not significant, F(1, 1006) = 0.15, p = .698, indicating that

significant, F(1, 1006) = 1.66, p = .199, indicating that change in depression over time

practice and spirituality have been shown to improve quality of life because it has been

linked to greater mental and physical health (Krause, 2011; Weisman de Mamani et al.,

In this study, I found that depression decreased over time for people who prayed

but not for people who did not pray. By utilizing the pairwise comparison method, I was

able to demonstrate a difference in depression between Waves 1 and 2 for people who

prayed. Furthermore, when focusing on people who prayed there was a notable decrease

in depressive symptoms between Wave 1 and Wave 2. On the other hand, when

considering the people who did not pray, there was no difference in depression between

Waves 1 and 2. These findings are in accord with previous research. For example,

previous researchers have demonstrated that prayer is effective in treating depression

(Maciejewski et al., 2012). Ladd and Spilka (2002) also suggested that prayer is

In contrast, in this study the variables of ethnicity and gender did not influence the

effectiveness of prayer in reducing depressive symptoms. The use of prayer was not

as evidenced by subjective assessment of reduced depressive symptoms.

satisfaction, lower depression, and anxiety across adulthood (Hackney & Sanders, 2003).

Furthermore, having an active religious life seems to be effective in reducing depressive

symptoms (Sun et al., 2012).

The research design used in this study is unique because it is not typically used to

explore theses effects. To my knowledge, this is the first study where comparisons were

made between group means (scores on the CESD) and their variation among and between

groups across time while controlling for gender, ethnicity, and frequency of prayer. The

research gap addressed in this study was not the effect of prayer on depression, which has

effectiveness of prayer in the elderly population when controlling for ethnicity, and

gender over time. I did not find evidence of the effects of gender, ethnicity, or frequency

of prayer on depressive symptoms over time among the elderly.

The results of this research confirm previous findings and serve to supplement the

notion that prayer is negatively correlated with decreases in depressive symptoms over

time. Taylor et al. (2007) demonstrated that older adults who engage in prayer have

Prayer, as a coping technique, empowers the individual to make sense of and

manage the stressors of life. As I concluded, prayer can have positive benefits in

reducing depressive symptoms. Sun et al. (2012) suggested that a possible treatment for

depression could be patient-centered interventions that increase intrinsic religiosity. This

patient-centered intervention could use prayer and be reinforced by the SOC theory.

randomness, can be understood even in moments of personal pain. This is called

comprehensibility. Second, a person can cope with the stress of life the help of self and

others, which is called manageability. Stress can be managed and controlled. Third, the

meaningfulness. The most difficult conditions of life can have a purpose and a meaning.

For many, prayer, the intercourse with God, allows some to understand, cope with, and

Prayer generally occurs within a coherent religious or metaphysical framework.

Bonelli, Dew, Koenig, Rosmarin, and Vasegh (2012) demonstrated the importance of

Likewise, the effectiveness of prayer in reducing depressive symptoms was not

influenced by ethnicity or gender. The effectiveness of prayer appears to be related to its

persistent use over time. In other words, depression significantly decreased over time for

people who prayed. The act of prayer, like SOC, provides a sense of manageability over

depressive symptoms. This indicates that prayer may have some psychological benefits

that is not related to ethnicity or gender.

As with any study there are limitations that prevent it from being perfect. First, I

should stress that the study was conducted with elders in the United States. The findings

of this study may not be generalizable to other populations such as those outside the

Second, the findings of my study are limited to a relatively narrow intervention of

Christian prayer. Therefore, the assumption of effectiveness of prayer over time may not

et al., 2009).

Fourth, the means of quantifying the severity of depression was based on only

relationship between an independent variable and a dependent variable. While this type

of research is effective in establishing relationships between variables it has limitations.

For example, I had no control over other variables and thereby cannot manipulate them.

In the end, I cannot be certain that the independent variable caused the changes in the

dependent variable.

collected, and how. Also, I cannot definitively conclude causal relations from this

played a role. As noted, using archival data provides little or no control over the study

population, design, or measurements. As a result, important confounding variables may

not have been measured or recorded. In addition, archival data may not reflect the current

trends, habits, behaviors or attitudes of a culture. Furthermore, the published data set in

this study was not compiled to address the research questions that were outlined for this

study.

CMS beneficiary list which relates specifically to people who participate in the social pay

source insurance programs and may not adequately sample elderly adults in the upper

socioeconomic classes.

treatment interventions could be tailor made to suit the subgroups.

strongly believe that prayer can reduce depressive symptoms experience a greater

decrease in depressive symptoms than Caucasians who do not?” Furthermore, the

following question could be addressed: “Do African Americans who do not strongly

believe in the effectiveness of prayer report fewer symptoms of depression over time

compared to Caucasians who strongly believe that prayer can reduce depressive

“Organizational Religiousness” could be examined across time in determining the

effectiveness of prayer among this subgroup.

Future research projects could utilize the complete CESD-R instead of only eight

out of 20 questions. The scale was revised in 2004- the same year that the second wave

of data was collected. The data collection for future research could be expanded from

collected more frequently such as annually or twice annually. This would better explore

religious groups of elderly adults within the US. For example, Protestant Christians

Others interested in this topic could examine the variable of culture within the

United States in relationship to effectiveness of using Christian prayer in treating

Irish immigrants in New York, first generation Asian descendants living California, etc.)

could be compared to determine if this variable influences the relationship between

Implications

mental health outcomes. My findings indicate that the function of prayer (a direct

intercourse with God) has benefit in reducing depressive symptoms among the elderly.

treatment in the battle against depression among the elderly. Implementing prayer as a

facilities met criteria for three or more coexisting syndromes correlating with depression

such as falls, incontinence, loss of appetite, and weight loss. The reduction of depression

If used effectively, then prayer could be a cost-effective method of reducing

depressive symptoms. This could have an impact on the cost of treating depression and

as a result could to some degree lower the financial burden of mental health treatment

among the elderly. Prayer as a supplemental form of treatment could be prescribed by the

treating clinician.

those elderly who are religious the benefits of prayer could be honestly and openly

discussed. The religious–minded person seeking treatment could be encouraged to use

prayer as one of many interventions (along with psychotropic medication and