Supervisor support and organizational support the relationship between occupational distress.pdf

Chapter 1: Introduction to the Study

Introduction

In this study, I examined the moderating effect of social support (perceived

supervisor support and perceived organizational support) on the relationship between

occupational distress and somatic symptoms among Catholic clergy in the United States

using the stress-buffering model of social support as the theoretical framework. Members

of helping professions, such as clergy, are particularly vulnerable to the adverse effects of

occupational stress on actual health outcomes (Tice et al., 2021). The relationship

between occupational stress, social support, and somatic symptoms is essential in making

predictions regarding health outcomes, including chronic disease and poor mental health

(Eagle et al., 2019; LaRocco et al., 1980; Ozbay et al., 2007). Actual health outcomes

such as chronic disease and poor mental health interfere with the daily functioning of

clergy and the wide variety of skilled roles they perform (Doolittle, 2007; Tice et al.,

2021). Clergy exhibit significantly higher rates of stress, mortality, and chronic disease

diagnosis (diabetes, arthritis, high blood pressure, angina, and asthma) in comparison to

their nonclergy counterparts (Proeschold-Bell & LeGrand, 2012; Tice et al., 2021). These

high rates of stress, as well as their severity, often produce distress, which is stress that

has negative effects on the body and mind (Bienertova-Vasku et al., 2020; Chu et al.,

2024; Lu et al., 2021; Selye, 1974). Although research on occupational stress and social

support has been conducted, the moderating effect of social support on the relationship

between occupational distress and somatic symptoms among Catholic clergy in the

United States has been understudied. Understanding the relationships between social

support, occupational distress, and somatic symptoms is critical as their impact affects

both the well-being of clergy and their capacity to meet the social, cultural, spiritual, and

religious needs of parishioners.

Through this study, I aimed to narrow the gap in the literature by examining

whether social support (perceived supervisor support and perceived organizational

support) moderates the relationship between occupational distress and somatic symptoms

in Catholic clergy living in the United States. The roles of Catholic clergy differ

significantly from those of other professions. For instance, priests often struggle to find a

balance between their professional and personal lives compared to individuals in other

occupations (Ruiz-Prada et al., 2021). Unlike other professions, Catholic clergy do not

have a clear delineation between work life and nonwork life (Zickar et al., 2008).

Therefore, clergy are constantly exposed to occupational stress, even when they are not

directly engaged in their occupational roles.

This study enhances the understanding of the relationship between occupational

distress, social support, and somatic symptoms among clergy by using the stress-

buffering model as the theoretical framework. The results suggest that while supervisor

support can decrease the somatic symptoms associated with occupational distress,

organizational support can increase these symptoms. The insights gained can assist in

developing targeted interventions to ensure the well-being of clergy (Ruiz-Prada et al.,

2021). This study contributes to the body of knowledge on clergy health by highlighting

the significant moderating roles of supervisor and organizational support, and it suggests

areas for future research to provide a more comprehensive understanding of clergy well-

being. This supports the views of Miles and Proeschold-Bell (2013), emphasizing the

importance of tailored support systems in mitigating stress-related health issues among

clergy.

In Chapter 1, I discuss the background of the study and present the problem

statement along with the purpose of the study. The research questions and hypotheses

together with a theoretical model and nature of the study are reviewed in this section.

This chapter also includes a discussion of the operational definitions, assumptions, and

scope and delimitations. The chapter will then highlight the limitations and significance

of the study.

Background

Frequent relocation, lack of privacy, heavy demands on their time and physical

energy, and criticism from parishioners and other clergy are examples of work-related

stressors that can cause occupational stress for priests (Miles & Proeschold-Bell, 2013).

Wells (2013a) examined whether time spent in the ministry and the age of the clergy

predicted actual health outcomes. The researchers concluded that age and time in

ministry were significant predictors of the health status of clergy populations. The

researchers also found that the emotional and physical health status of clergy increased

when social support increased. Health outcomes were indicated by the rates of chronic

diseases related to clergy occupation, with positive health outcomes indicating a lower

rate of chronic disease. In contrast, adverse health outcomes showed higher rates of

chronic disease. The negative health outcomes associated with stress affected the clerical

capacity to perform parish duties (Wells, 2013a, 2013b).

Lin et al. (1979) described social support as the accessible support available from

individuals, groups, and communities due to their social ties. Others have defined it as the

individual's social network's support (emotional, instrumental, and informational) that is

available to help the individual cope with stress (Cohen, 2004). Studies that explored the

relationship between social support and its stress-related protective factors among

different types of populations concluded that one of the more important protective factors

against stress is social support (Cohen et al., 1986; Cohen & Wills, 1985; Shaw et al.,

2021). A study by Shaw et al. (2021) found that increased levels of social support were

associated with lower rates of stress and improved health outcomes, specifically

decreased depression levels, among clergy. This suggests that social support may play a

crucial role in promoting the mental health and well-being of this population. According

to several studies, social support has been found to be perceived by clergy as a means of

coping with the daily stressors associated with their profession (Bricker & Fleischer,

1993; Edwards et al., 2022; Pietkiewicz & Bachryj, 2016). However, Ruiz-Prada et al.

(2021) also revealed that a considerable proportion of Italian Catholic priests (23%)

reported feeling discouraged due to a lack of support and continued to report a lack of

social support from parishioners and collaborators, as well as a lack of networking with

other colleagues, as factors that worsened the occupational stress they were already

experiencing in their jobs.

Trevino and McConnell (2014) explored the relationship between religious

coping styles and health outcomes in patients with cardiovascular disease. The authors

defined positive religious coping as the act of seeking the presence of God when faced

with stress, whereas negative religious coping was the act of rejecting the presence of

God when faced with stress (Trevino & McConnell, 2014). It was observed that positive

religious coping, including strategies such as seeking spiritual support from God, clergy,

and church members, decreased the levels of stress and improved quality of life.

Kane (2017) conducted research to determine how active priests (N = 18) felt

about the physical and cognitive changes that come with age, the stress in their life, and

the need of self-care. The study showed that 68% of clergy lacked confidence in their

bishop and his abilities as a leader of diocesan pastoral activity. Similarly, 59% of

participants indicated that they received little or no support from their bishop in response

to excessive or unreasonable demands from parishioners that greatly exceeded their

abilities and availability (Kane, 2017). Kane's findings were backed by a more recent

study by Ruiz-Prada et al. (2021), who conducted an exploratory review of the literature

on the occupational stress of Catholic priests. The purpose of their quantitative cross-

sectional study was to measure the clergy occupational distress, social support, mental

health, and spiritual wholeness of clergy in Florida. Compared to national averages,

clergy in this study displayed higher levels of occupational stress and depression (Ruiz-

Prada et al., 2021). According to the authors, these results should raise broad concerns

regarding the mental health of clergy and the support that is available to them (Ruiz-

Prada et al., 2021). The study also demonstrated that comprehensive assessments of

validated instruments such as the Clergy Occupational Distress Index (CODI) and the

Patient Health Questionnaire (PHQ-9) can provide insight into the health of clergy.

Proeshold-Bell and LeGrand (2012) conducted a comparative study on clergy and

nonclerical populations in which they explored the association between health

perceptions and actual health outcomes (e.g., chronic disease rates). Proeshold-Bell and

LeGrand (2012) categorized the clergy population as parish leaders who had at least 5

years of service in the ministry. The nonclergy population comprised any other

population not serving in a parish (Proeshold-Bell & LeGrand, 2012). The clergy

populations had lower actual health outcomes demonstrated by higher rates of chronic

diseases compared to the nonclergy populations. Furthermore, clergy populations had

optimistic perspectives on health perceptions that resulted in unrealistic health outcomes.

The authors recommended further examination of the relationship between health

perceptions among clergy populations and actual health outcomes (Proeschold-Bell &

LeGrand, 2012).

Ruiz-Prada et al. (2021) conducted a review of the literature on the relationship

between the experience of stress and burnout syndrome among Catholic priests. The

study found that Catholic priests encounter a variety of risk factors associated with work-

related stress, including distrust from society, lack of sufficient support, living alone,

complacent and avoidant coping styles, excess demands, and unclear boundary between

priestly roles and life roles. These risk factors are responsible for the increased stress and

burnout that Catholic priests undergo in their priestly role. The studies in the review also

identified significant protection factors such as leading an active spiritual life, social

support (e.g., from superiors, colleagues, collaborators, and parishioners), strengthening

personal identity, finding enough resting time, eating a balanced diet, frequent physical

exercise, an approach-based coping style, and promoting optimism. The social and health

outcomes of stress and burnout among Catholic priests include alcoholism, smoking,

depression, anxiety, cardiovascular disease, diabetes, and obesity. The researchers found

that strengthening protective factors as well as minimizing the influence of risk factors

can help to improve the health outcomes of the clergy.

The consequences of stress on clergy are extensive and include harmful physical

and mental health implications (Sielaff et al., 2021). Compared to the general population,

clergy have higher rates of stress, mortality, and chronic illness diagnosis (e.g., diabetes,

arthritis, high blood pressure, angina, and asthma; Proeschold-Bell & LeGrand, 2012;

Tice et al., 2021). Despite studies on both professional stress and social support, the

relationship between occupational stress and somatic complaints among Catholic clergy

in the United States has not received sufficient attention. Even less is known about the

moderating effect of social support on the link between professional stress and somatic

symptoms in Catholic clergy. In the current study, I used the stress-buffering model of

social support to understand the moderating effect of social support on the relationship

between occupational distress and somatic symptoms among a sample of clergy (Cohen

& Wills, 1985). This study was needed to investigate the role that occupational distress,

social support, and somatic symptoms have in predicting actual health outcomes in

clerical populations due to the influence their health may have on the quality of service

they provide to their parishioners.

Problem Statement

According to Clarke et al. (2022), the occupational demands of their pastoral

work expose priests to conditions that result in increased occupational stress, burnout,

emotional exhaustion, feelings of isolation, and personal challenges. Additionally, Webb

and Chase (2019) found that elevated levels of occupational distress were significantly

associated with an increased risk of negative health outcomes such as high blood

pressure, diabetes, chronic stress disorder, depression, anxiety, and prolonged sitting

time. They suggested that occupational distress might negatively affect the health of full-

time Christian clergy, particularly those who are younger, and advocated for further

research on the temporal relationships among occupational distress, health, and health

behaviors among full-time clergy (Webb & Chase, 2019). Similarly, Shaw et al. (2021)

found that clergy had a depression rate of 12.9%, which is worse than the previously self-

reported rate of 11.1%, among United Methodist clergy study participants and the

published national average for 2017 of 7.9% (National Institute of Mental Health, 2019;

Proeschold-Bell et al., 2013). They also found an inverse correlation between the number

of sources of social support and depression levels among clergy (Shaw et al., 2021).

Wells (2013a, 2013b) highlighted the significance of determining the relationship

between occupational stress, health perceptions, and coping style in predicting the actual

health outcomes among the clergy population. In this context, actual health outcomes

refer to chronic diseases that include cancer, diabetes, obesity, and cardiovascular

diseases, among others. In addition, Webb and Chase (2019) found that a significant

proportion of clergy reported having chronic diseases such as high blood pressure

(33.5%), high cholesterol (29.0%), arthritis (15.4%), depression (14.9%), and anxiety

(12.7%), and over half of the clergy were classified as obese. Logistic regression models

demonstrated that increasing age, body mass index (BMI), and occupational distress were

associated with an increased likelihood of reporting a diagnosis of high blood pressure,

high cholesterol, type 2 diabetes, and arthritis (Webb & Chase, 2019). Harmon et al.

(2021) also noted that work-related stress and church traditions can be barriers to healthy

behaviors among clergy, including maintaining a healthy weight. The association

between occupational distress, social support, and real health outcomes among the clergy

population has been generally understudied. Only a small number of studies have been

done specifically focusing on clergy stress and their mortality rates. Even less is known

about the moderating effect of perceived social support on the relationship between

occupational distress of clergy and somatic symptoms. Somatic symptoms have been

described as predictors of poor physical health, mental health, and everyday functioning

(Bohman et al., 2018; Henningsen, 2022).

It is important to determine the extent of the relationship between occupational

distress, social support, and actual health outcomes among the clergy population because

this affects their work performance and their efficacy in serving parishioners. Research

shows that the occupational demands of the pastoral work of priests expose them to

conditions that result in the development of occupational stress (Clarke et al., 2022;

Proeschold‐Bell et al., 2015). Furthermore, role-related stress and adversity pose

significant challenges to clergy members' resilience and well-being. Researchers also

found that clergy members face complexity and ambiguity in their roles, which can lead

to difficulties in coping with stressors (Clarke et al., 2022). This can be attributed to the

different roles that clergy perform in their occupation. Currently, as part of their pastoral

work, priests take on many roles such as counselor, caregiver, minister, leader, role

model, speaker, church representative, administrator, supervisor, therapist, social worker,

spiritual director, educator, and negotiator (Clarke et al., 2022; Kay, 2000; Kuhne &

Donaldson, 1995; Miles & Proeschold-Bell, 2013; Pickard & Guo, 2008).

Lin et al. (1979) described social support as the accessible support available from

individuals, groups, and communities due to social ties. Others have defined it as the

individual's social network's support (emotional, instrumental, and informational) that is

available to help the individual cope with stress (Cohen, 2004). Several studies have

explored the significance of social support in mitigating the negative impact of

occupational stress among clergy. Shaw et al. (2021) found that higher levels of social

support were associated with lower levels of depression among clergy. Similarly, Webb

and Chase (2019) found that perceived social support was negatively associated with

occupational distress among Christian clergy. The study by Harmon et al. (2021)

highlighted the importance of social support in promoting healthy behaviors among

clergy and their spouses. In addition, Proeschold-Bell et al. (Eagle et al., 2019; Miles &

Proeschold-Bell, 2013) identified social support as a potential protective factor against

burnout among clergy. These findings suggest that social support may play a significant

role in reducing the negative impact of occupational stress on the mental health and well-

being of clergy. There remains a gap in the literature concerning the extent to which

social support moderates the relationship between job-related stress and somatic health

symptoms among clergy. Further research is needed to explore the potential protective

effects of social support in reducing the negative impact of occupational distress on

somatic health symptoms among this population. This study was designed to explore the

moderating effect of social support in the relationship between stress and somatic

symptoms among the clergy population in the United States.

Purpose of the Study

The purpose of this quantitative nonexperimental correlational study was to

examine the extent to which perceived supervisor support and perceived organizational

support moderate the relationship between occupational distress (IV) and somatic

symptoms (DV) among clergy.

Research Questions and Hypotheses

RQ1: To what extent does occupational distress, as measured by the Clergy

Occupational Distress Index, relate to somatic health symptoms (gastrointestinal

problems, headaches, sleep disturbance, and respiratory infections), as measured by the

Physical Health Questionnaire, among Catholic clergy working in the United States?

H01: Occupational distress is not a significant predictor of somatic health

symptoms (gastrointestinal problems, headaches, sleep disturbance, and respiratory

infections).

H1: Occupational distress is a significant predictor of somatic health symptoms

(gastrointestinal problems, headaches, sleep disturbance, and respiratory infections).

RQ2: To what extent does supervisor support, as measured by the Survey of

Perceived Supervisor Support, relate to somatic health symptoms (gastrointestinal

problems, headaches, sleep disturbance, and respiratory infections), as measured by the

Physical Health Questionnaire, among Catholic clergy working in the United States?

H02: Supervisor support is not a significant predictor of somatic health symptoms

(gastrointestinal problems, headaches, sleep disturbance, and respiratory infections).

H1: Supervisor support is a significant predictor of somatic health symptoms

(gastrointestinal problems, headaches, sleep disturbance, and respiratory infections).

RQ3: To what extent does organizational support, as measured by the Survey of

Perceived Supervisor Support, relate to somatic health symptoms (gastrointestinal

problems, headaches, sleep disturbance, and respiratory infections), as measured by the

Physical Health Questionnaire, among Catholic clergy working in the United States?

H03: Organizational support is not a significant predictor of somatic health

symptoms (gastrointestinal problems, headaches, sleep disturbance, and respiratory

infections).

H3: Organizational support is a significant predictor of somatic health symptoms

(gastrointestinal problems, headaches, sleep disturbance, and respiratory infections).

RQ4: To what extent does supervisor support moderate the relationship between

occupational distress and somatic health symptoms (gastrointestinal problems, headaches,

sleep disturbance, and respiratory infections) among Catholic clergy working in the

United States?

H04: Supervisor support does not moderate the relationship between occupational

distress and somatic health symptoms (gastrointestinal problems, headaches, sleep

disturbance, and respiratory infections).

H4: Supervisor support does moderate the relationship between occupational

distress and somatic health symptoms (gastrointestinal problems, headaches, sleep

disturbance, and respiratory infections).

RQ5: To what extent does organizational support moderate the relationship

between occupational distress and somatic health symptoms (gastrointestinal problems,

headaches, sleep disturbance, and respiratory infections) among Catholic clergy working

in the United States?

H05: Organizational support does not moderate the relationship between

occupational distress and somatic health symptoms (gastrointestinal problems, headaches,

sleep disturbance, and respiratory infections).

H5: Organizational support does moderate the relationship between occupational

distress and somatic health symptoms (gastrointestinal problems, headaches, sleep

disturbance, and respiratory infections).

Theoretical Framework for the Study

Cohen and Wills (1985) conceptualized the stress-buffering model of social

support (SBMSS). The model proposes that social support mitigates the negative impacts

of stress and enhances the outcomes of stressful experiences (Cohen et al., 1986). It also

posits that social support can protect against or mitigate the negative consequences of life

stress that are likely to have an adverse impact on mental health. According to this model,

the mitigating effects are most pronounced when individuals are under extreme stress and

feel that support is available and offered on demand. This model, also referred to as the

stress-buffering hypothesis, asserts that social support modulates the link between

perceived stress, health, and disease.

The approach permits researchers to examine whether the perceived availability

of social support protects individuals from stress and improves outcomes that may impact

their well-being (Cohen & Wills, 1985). The premise of the SBMSS model is that some

resources can mitigate the impact of negative life events on a person's health state. When

unpleasant occurrences occur regularly, they can add up and cause health issues.

However, life stress may have less of an effect on those with greater psychosocial

resources, which may function as a buffer or insulator between the stressors and the

health effects (Ditzen & Heinrichs, 2014). Thus, those with greater resources suffer less

stress. Stress can also be caused by job stresses in high-demand, low-control

organizations. Most research conducted on nonclergy groups has associated elevated

stress levels with sadness, anxiety, and physical ailments (Creswell et al., 2014).

However, buffering resources can substantially reduce the negative health effects of

stress (Creswell et al., 2014).

Nature of the Study

The study was quantitative in nature as it was appropriate to examine the

relationships among variables. A nonexperimental correlational design was utilized to

determine the extent to which perceived supervisor and organizational support moderate

the relationship between occupational distress (IV) and somatic symptoms (DV) among

the clergy. A cross-sectional strategy is typically used in surveys when data are collected

at one point in time as opposed to data collected over time (Vicente-Galindo et al., 2017).

The choice of survey was based on the rationale that it is most practical and effective in

collecting data from a large population (Vicente-Galindo et al., 2017).

The population of the study was Catholic priests who had practiced their

profession in the United States for at least 2 years, were at least 27 years old, and were

currently living in the United States. Convenience sampling, which is a nonprobability

sampling strategy, was used to recruit a sample of clergy who met the inclusion criteria

for participation. The data were uploaded and analyzed using the Statistical Package for

Social Sciences (SPSS) version 27.0 software. Standard multiple regression analysis (i.e.,

enter method) was used to determine the extent to which perceived supervisor support

and perceived organizational support moderate the relationship between occupational

distress and somatic symptoms among Catholic clergy.

Definitions

Stress: The body's nonspecific response to any demand placed upon it. The stress

response is a complex biological and psychological reaction aimed at restoring balance or

homeostasis (Selye, 1956).

Occupational stress: Stress experienced in the workplace, leading to adverse

emotional and physiological effects such as anxiety, depression, and burnout. It impairs

an individual's well-being and productivity (Le Fevre et al., 2003).

Clergy occupational stress: Stress that clergy experience due to unique stressors

related to their profession, including excessive demands from congregation members,

personal criticism, feelings of loneliness or isolation, and challenges faced within their

congregation (Frenk et al., 2013).

Perceived social support: The perceived availability, adequacy, and quantity of

different types of support (emotional, practical, informational, and financial; Nazari et al.,

2020).

Perceived supervisor support: The employee’s perception that the supervisor

values their contribution and cares about their well-being (Eisenberger et al., 2002).

Perceived organizational support: The employee’s perception that the

organization values their contribution and cares about their well-being (Eisenberger et al.,

2002).

Somatic symptoms: Involuntary physical symptoms that occur in response to

psychological and emotional distress, typically without a biological cause (Kurlansik &

Maffei, 2016). Different terms have been proposed, such as somatization, unexplained

somatic complaints, somatoform disorders, and somatic symptom disorder (Alalawi et al.,

2022; American Psychiatric Association, 2013; Kramer et al., 1979). Somatic symptoms

have also been defined as a type of physical strain (Schat et al., 2005).

Catholic priest: A member of the clergy ordained to the sacerdotal or pastoral

office by the Catholic church. Historical views of priests include spiritual teachers,

professors, writers, and counselors (Zickar et al., 2008). Currently, as part of their

pastoral work, priests take on many roles such as counselor, caregiver, minister, leader,

role model, speaker, church representative, administrator, supervisor, therapist, social

worker, spiritual director, educator, and negotiator (Kay, 2000; Kuhne & Donaldson,

1995; Miles & Proeschold-Bell, 2013; Pickard & Guo, 2008).

Assumptions

There were several relevant assumptions in this study. The first assumption was

that participants would respond to the survey questions honestly. The data collection

process was designed to maintain anonymity and confidentiality to promote honest

responses when completing the survey. The final assumption was that there would be no

researcher bias that could potentially contaminate the data.

Scope and Delimitations

The scope of this study was on occupational distress, perceived supervisor

support, perceived organizational support, and somatic symptoms using the stress-

buffering model of social support. The main objective of this study was to assess if

perceived supervisor support and perceived organizational support have a moderating

effect on the relationship between occupational distress and somatic symptoms among

Catholic clergy. This population is significantly different from other occupational groups

in that Roman Catholic priests generally regard their work roles as a vocation rather than

a job (Zickar et al., 2008). The sample was comprised of and limited to priests over the

age of 27 who had at least 2 years of experience as a priest and had lived in the United

States for the last 3 years.

Limitations

Because the study used convenience sampling, the representativeness of the

sample and, therefore, the generalizability of the results may have been limited,

guaranteed only when participants are randomly selected. Another limitation of this study

was social desirability. Social desirability is the conscious or unconscious need to

respond in a socially or culturally appropriate manner (Larson, 2019). In some instances,

it may be used to make oneself or, in this instance, one's occupation or field, appear more

favorable. Priesthood is generally viewed negatively by a portion of the population. This

should be acknowledged, as the priest may feel obligated to respond in a socially or

culturally appropriate manner. To reduce the likelihood of social desirability

contaminating the data, the study reinforced the idea that all information submitted by the

participant was anonymous; no identifying information was collected, nor was their

location identified.

Significance

Clergy exhibit significantly higher rates of stress, mortality, and chronic disease

diagnosis (diabetes, arthritis, high blood pressure, angina, and asthma) in comparison to

their nonclergy counterparts (Proeschold-Bell & LeGrand, 2012; Tice et al., 2021).

Although research on occupational stress and social support had been conducted, the

moderating effect of social support on the relationship between occupational distress and

somatic symptoms among Catholic clergy in the United States was understudied. In this

study, I examined the extent to which social support moderates the relationship between

occupational distress and somatic symptoms among Catholic clergy. The study may lead

to positive social change by adding new data to the limited amount of literature on the

clergy population. Furthermore, this study can help employers, organizations, and health

agencies create better social support strategies focused on the needs of the clergy

population and other high-stress occupations. This would be beneficial to the clergy as

well as the parishioners they serve because occupational distress has a significant

influence on daily functioning of the clergy.

Summary

Occupational stress develops from the inability to cope with the demands of the

workplace due to the lack of availability and may negatively impact a person's physical

health and mental health and increase their risk of occupational distress. The occupational

roles of Catholic clergy are significantly different from those of other occupational

populations. For example, a delineation between work-life and nonwork life exists in

other occupations, which is not the case for priests. The purpose of this study was to

examine the moderating effect of social support on the relationship between occupational

distress and somatic symptoms among Catholic clergy, a population that is significantly

different from other occupational groups covered in most studies.

Chapter 2 provides a description of the literature search strategy followed by a

discussion of the stress-buffering model of social support, which served as the theoretical

framework. This chapter also provides a thorough review of the current literature on the

roles of Catholic clergy in the United States, occupational stress among clergy, social

support, and somatic symptoms and health among clergy.

Chapter 2: Literature Review

Introduction

Catholic priests are part of a professional group in which interaction and social

function are particularly important to their church, parish (ecclesiastical territory), and the

people who are part of the parish (i.e., parishioners; Vicente-Galindo et al., 2017).

Research has shown that the occupational demands of their pastoral work expose priests

to conditions that result in the development of occupational stress (Madukwe et al., 2019;

Miles & Proeschold-Bell, 2013). As part of their pastoral work, priests take on many

roles such as a counselor, caregiver, minister, leader, role model, speaker, church

representative, administrator, supervisor, therapist, social worker, spiritual director,

educator, negotiator, and local community leader (Kay, 2000; Kuhne & Donaldson, 1995;

Miles & Proeschold-Bell, 2013; Pickard & Guo, 2008; Zembylas et al., 2019).

Research shows that the numerous responsibilities clergy must accomplish within

faith-based organizations may put them under a great deal of psychosocial stress (Kay,

2000; Kuhne & Donaldson, 1995; Miles & Proeschold-Bell, 2013; Pickard & Guo, 2008;

Ruiz-Prada et al., 2021; Zembylas et al., 2019). Frequent relocation, lack of privacy,

heavy demands on their time and physical energy, and criticism from parishioners and

other clergy are additional work-related stressors that can cause occupational stress

among priests (Miles & Proeschold-Bell, 2013; Ruiz-Prada et al., 2021). Additionally,

members of helping professions, such as clergy, are particularly vulnerable to the adverse

effects of occupational stress on actual health outcomes (Tice et al., 2021). The

relationship between occupational stress, social support, and somatic symptoms is

essential in making predictions regarding health outcomes, including chronic disease and

poor mental health (Eagle et al., 2019; LaRocco et al., 1980; Ozbay et al., 2007).

Therefore, the purpose of this quantitative study was to address a gap in the literature by

determining the extent to which perceived social support moderates the relationship

between occupational stress (IV) and somatic symptoms (DV) among clergy working in

the United States.

According to the National Institute for Occupational Safety and Health (1999),

occupational stress is defined as the stress that an individual develops due to

misalignment between the needs of a job and the capabilities of the worker, accessible

resources, and the expectations of the hiring company or organization. Under the person–

environment fit theory, occupational stress results from a mismatch between the

employee's capabilities and the expectations of the work environment. This mismatch

may be the result of the individual's aptitudes and skills not matching those required by

their profession or their employment failing to meet their specific requirements and

expectations (de Mézerville, 2012; Luceño Moreno et al., 2004; Ruiz-Prada et al., 2021).

Additionally, research has shown that occupational stress developed from factors

in the psychosocial work environment has been linked to the development of workers'

adverse physical and emotional responses (Melchior et al., 2007; Ruiz-Prada et al., 2021).

Several studies have assessed different occupational work environments and confirmed

that a high-stress work environment is a predictor of poor health and well-being (Ibrahim

et al., 2021; Kaburi et al., 2019; Sonnentag, 2018; Yu et al., 2008). Some of the factors

that demonstrated a link with poor well-being were occupational stress, high work

demands, inadequate job stability, low reward, and low social support (Ibrahim et al.,

2021; Kaburi et al., 2019; Sonnentag, 2018; Yu et al., 2008).

Various studies have focused on the factors that affect the health of the clergy

population. For example, a study reported that stress negatively impacts priests' overall

health, reducing their engagement in healthy behaviors (Proeschold-Bell & LeGrand,

2012). The quantitative study examined the physical health functioning among a sample

of clergy and compared it to a nonclergy population. Results showed that clergy exhibit

higher rates of chronic diseases compared to their nonclergy counterparts (Proeschold-

Bell & LeGrand, 2012). Other researchers have also identified a clear relationship

between an individual’s stress level and health outcomes (Proeschold-Bell et al., 2011). It

was also observed that the way that clergy cope with pastoral stress can positively or

negatively impact their health (Proeschold-Bell & LeGrand, 2012). The stress-buffering

model is frequently used by researchers to assess whether the perceived availability of

social support buffers stress levels and consequently improves well-being (Cohen &

Wills, 1985).

Researchers have also pointed out that social support may decrease the prevalence

of occupational stress and reduce the impact of stressors (Viswesvaran et al., 1999).

Thus, the effects of occupational stress and related stressors may be different depending

on the availability of resources and personal characteristics of the priest (Carroll, 2006;

Dewe, 1987; Rodgerson & Piedmont, 1998). A meta-analysis conducted by Viswesvaran

et al. (1999) on the different models for the role of social support in the process of work

stress found that social support decreased the strains experienced, lessened perceived

stressors, and moderated the stressor–strain relationship. While research on the negative

impacts of occupational stress on health exists, there is a gap in the existing literature

needed to determine how social support affects the relationship between occupational

stress and health among priests.

Chapter 2 begins with a description of the literature search strategy followed by a

discussion of the stress-buffering model of social support, which served as the theoretical

framework. The literature review includes discussions pertaining to the roles of Catholic

clergy in the United States, occupational stress among clergy, somatic symptoms and

health issues among clergy, and social support. A summary section will be included to

provide an explanation of the gap in literature and how I attempted to fill that gap through

the present study.

Literature Search Strategy

The databases used in the search were EBSCO Host, PubMed, Google Scholar,

ProQuest, APA PsycEXTRA, APA PsycARTICLES, and APA PsycINFO. The articles

searched spanned from the 1980s to the present, with most studies focusing on

occupational stress and health issues. The key search terms and their combinations were

clergy disease, clergy health, clergy stress, life stress, social support, clergy coping,

chronic diseases, health outcomes, somatic symptoms, secondary trauma, secondary

traumatic stress, vicarious trauma, compassion fatigue, coping styles, health perceptions,

religious coping, organizational support, self-regulation, stress-buffering, physical

health, and emotional health. Other combinations used in the search were Catholic clergy

burnout, burnout clergy, burnout Catholic clergy, Catholic priests and secondary stress,

compassion fatigue in priests, priests and secondary trauma, chaplains and vicarious

trauma, clergy stress, clergy occupational stress, clergy somatic symptoms, clergy social

support, and priests' somatic stress and social support. For a more refined search, the key

terms used were compassion fatigue and compassion satisfaction, secondary traumatic

stress and life satisfaction, social support and secondary traumatic stress, clergy stress

and self-care, emotional intelligence and the clergy, trauma counseling, clergy mental

health, and clergy indirect trauma.

Theoretical Foundation

The stress-buffering model of social support (SBMSS) was developed by Cohen

and Wills (1985). The model asserts that social support buffers the detrimental effects of

stress and improves the outcomes of stressful events (Cohen et al., 1986; Cohen & Wills,

1985). The model holds that social support can offer protection or moderate the adverse

effects of stress experienced in life likely to affect mental health. According to this

model, the moderating effects are most significant when people are under high duress and

perceive that support will be offered on demand. Otherwise known as the stress-buffering

hypothesis, this model claims that social support influences the relationship between

perceived stress, health, and disease.

The model allows researchers to study whether the perceived availability of social

support protects persons from stress and improves the outcomes that may affect their

well-being (Cohen & Wills, 1985). The concept underlying the SBMSS model is that

some resources are beneficial in reducing the influence of adverse life events on a

person's health status. When adverse events occur repeatedly, they can accumulate and

bring about health problems. However, life stress may have less impact on individuals

with more psychosocial resources where the resources serve as a buffer or insulating

factors between the stressors and the health outcomes (Ditzen & Heinrichs, 2014).

Consequently, individuals with more resources experience stress to a lesser extent. One

way stress is measured is through the number of adverse events that a person has

experienced over a specific duration (Ditzen & Heinrichs, 2014). Some of the adverse

events may include severe financial difficulty, loss of a loved one, and job-related strains,

among others. Job strains in workplaces with high work demand and low control can also

be sources of stress. Elevated stress levels have been linked with depression, anxiety, and

physical problems, according to most studies conducted on nonclergy populations

(Creswell et al., 2014). However, the buffering resources can significantly minimize the

adverse health effects of stress (Creswell et al., 2014).

Various types of stress-buffering agents exist, one of them being social support.

The buffering effect, or moderator, is often referred to as both moderator and mediational

and suppressor effects (Viswesvaran et al., 1999). Viswesvaran et al. (1999) conducted a

meta-analysis on the different roles of social support in the process of work stress and

identified that social support had a moderating effect on strains experienced, lessened

perceived stressors, and moderated the stressor–strain relationship. For example, social

support moderates the effects of occupational stress of workers (Viswesvaran et al.,

1999). Perceived organizational support and perceived supervisor support have also been

shown to moderate the effects of stress. Jain et al. (2013) investigated the influence of

perceived organizational support as a moderator in the relationship between organization

stressors and organizational citizenship behaviors among operator-level employees

working within the business process outsourcing sector in India. Perceived organizational

support had a significant positive relationship with occupational stress, which improved

the psychological and emotional well-being of employees (Jain et al., 2013).

Evidence of the stress-buffering effect of social support was found in a study that

researched the effects of occupational stress on the mental health of a sample of 325 male

power plant employees (Bromet et al., 1988). A significant moderating effect was

observed from social support between occupational stress and the psychological and

emotional well-being of employees. The study found that workers with higher workplace

stressors had a higher probability of experiencing an episode of affective disorder if they

received lower levels of coworker support; if higher levels of coworker support were

received, workers with higher workplace stressors had a lower probability of

experiencing an episode of affective disorder (Bromet et al., 1988).

Among clergy, Proeschold-Bell et al. (2015) found a significant relationship

between work-related stress and mental health. Results indicated that social support

buffered the negative impact of work-related stress on the mental health among clergy.

Wells (2013) conducted a study that explored the relationship between stress and the

health of clergy and discovered that congregational and denominational support were

moderators that decreased the adverse effects of stress on the health of clergy. Zickar et

al. (2008) investigated the relationship between role stressors and job attitudinal variables

and the potential moderating influence of social support in a sample of 190 Roman

Catholic priests and found that role stressors resulted in negative job attitudes such as

turnover intention and low job satisfaction (Zickar et al., 2008). The study applied the

stress-buffering hypothesis focusing on several sources of social support and found that if

priests had sources of social support, there was a higher probability that it buffered the

adverse effects of occupational stress on job satisfaction and their intentions to quit.

Thus, the stress-buffering model can be applied to Catholic clergy populations to evaluate

the moderating effect of social support on the relationship between occupational stress

and health.

Literature Review Related to Key Variables and/or Concepts

Role of Catholic Clergy

The Roman Catholic church has a unique organizational structure (Nkonge

Kagema, 2012). This church is a global organization with a hierarchical structure that

moves from the Vatican to the local dioceses (Kane & Jacobs, 2017). The leader of each

local church is the bishop, who is in a leadership role supervising the priests. The bishop

also manages the property owned by the local church. The Pope appoints the bishop and

determines the local church to which they are posted. The bishop is considered the final

decision-maker and authority for the local church with the assistance of his curia (i.e.,

priests serving as officials who assist the diocesan bishop). The other function of the local

bishop is overseeing the ecclesial staff. The bishop works closely with the priests who are

assigned day-to-day duties in different ministries or parishes. Priests are ordained and

assigned from one church to another by the bishops (Kane, 2008). The role of the priest is

to represent the bishop at the local parish, undertaking responsibilities such as offering

pastor services and spiritual care (Kane, 2008). The roles of priests have changed over

time. Priests have been viewed historically as spiritual teachers, professors, writers, and

counselors (Zickar et al., 2008). As part of their pastoral work, priests take on many roles

such as counselor, caregiver, minister, leader, role model, speaker, church representative,

administrator, supervisor, therapist, social worker, spiritual director, educator, and

negotiator (Kay, 2000; Kuhne & Donaldson, 1995; Miles & Proeschold-Bell, 2013;

Pickard & Guo, 2008).

The structure of the Catholic church follows the servant-leadership model (Joo et

al., 2018; Tran & Spears, 2020). This structure was proposed and designed in the early

centuries of the western and eastern patristic literature (Kgatle, 2015; Niewold, 2007).

This model is inscribed in modern theological and spiritual writings (Kane, 2014).

Furthermore, this model is also referenced in the New Testament through the teachings of

Jesus Christ. While the servant-leadership model implies that leaders should be humble

and willing to serve all people, priests and their congregations are encouraged by the

Catholic tradition to consider the bishop as the spiritual father in their dioceses (Kane,

2014). The patristic as well as theological teachings have long stressed the need for

respectful and loving leadership that is embedded in the New Testament teachings

(Patterson, 2010). Patience, equality, trust, kindness, respect, and love in the Biblical

teachings underpin the qualities of respectful leadership (Anderson, 2021). Van

Quaquebeke and Eckloff (2010) advanced the respectful leadership qualities that have

striking similarities with the spiritual leadership qualities highlighted in scriptures. These

authors suggested that respectful leadership comprised behaviors such as being error-

friendly, acknowledging equality, considering needs, conferring responsibility, valuing,

and trusting.

Respectful leadership holds that subordinates who feel respected by their

superiors are more likely to work hard toward the goals of the organization compared to

those who feel disrespected (Kane & Jacobs, 2017). Further, the clergy are likely to

perceive their activities positively as well as record fewer physical, psychological, and

emotional complaints (Kane & Jacobs, 2017). Bishops, in their part, can demonstrate

respectful leadership consistent with research and New Testament teachings by

demonstrating behaviors that foster respect. Bishops can also show they value individuals

within their laity. They should share power and responsibility as well as encourage

approachability from the congregation and other personnel within the congregation. The

role stressors experienced by Catholic church leaders such as bishops can have a negative

impact on the clergy's health, ministerial careers, and the functioning of their

congregation as a result of occupational stress.

Occupational Stress Among Clergy

Prasad and Vaidya (2020) defined occupational stress as pressure on employees

caused by factors associated with the employment. Other researchers have found that the

occupational demands of the pastoral work of priests expose them to conditions that

result in the development of occupational stress (Proeschold‐Bell et al., 2015). These

researchers explained that frequent relocation, lack of privacy, heavy demands on their

time and physical energy, and criticism from parishioners and other clergy are additional

work-related stressors that can cause occupational stress among priests. Proeschold-Bell

et al. (2015) used a sample of church-appointed clergy (N = 1,476) to examine the

variables (e.g., clergy-specific variables, variables shown to relate to affect across

populations, demographics, and social desirability) that may reduce negative mental

health and increase positive mental health. Social support, social isolation, and financial

stress were directly related to the level of mental health of clergy and had a larger effect

size than other variables. Financial stress, social isolation, and social support together

explained between 34% and 8% of the variance in both negative and positive affect

outcomes. Thoughts of leaving the ministry and congregation demands were significantly

related to both negative and positive affect.

Clarke et al. (2022) conducted a qualitative descriptive study to explore the types

of adversity that Christian clergy members face and their resilience. The researchers

utilized a national survey, one-on-one interviews, and interpretation panels to collect data

from 12 current or former Christian clergy members. Various types of adversity that

clergy encounter were identified through the study, including unrealistic expectations

from congregations, high workload and emotional labor, financial pressure, and

denominational expectations (Clarke et al., 2022). The findings showed that role-related

stress and adversity pose significant challenges to clergy members' resilience and well-

being. The researchers found that clergy members face complexity and ambiguity in their

roles, which can lead to difficulties in coping with stressors (Clarke et al., 2022). One of

the themes identified was isolation, which may contribute to social support being an

important factor for clergy members' resilience (Clarke et al., 2022). The study affirmed

that role complexity is a form of adversity that clergy members face, which can impact

their resilience and well-being (Clarke et al., 2022). In conclusion, this study provided

insights into the challenges that clergy members encounter and highlights the importance

of social support to enhance their resilience and well-being.

The working relationship between Catholic bishops and their priests has been

noted by Kane and Jacobs (2017) as a potential source of occupational stress.

Historically, the relationship between bishops and their priests have been strained

because of allegations of sexual abuse priests endured in 2002 (Kane & Jacobs, 2017).

According to survey research conducted by the Center for Applied Research in the

Apostolate, the relationship between priests and their bishops had deteriorated following

the 2002 media revelations accusing priests of sexually abusing children that was covered

up by the church (Gautier et al., 2012). After the child-abuse scandal, the survey showed

that 68% of priests reported that they had little confidence in their assigned bishops, who

they believed failed to protect them from allegations that they were sexually abusing

children. The survey also demonstrated that 64% of priests believed that the church was

not being handled properly. Of the participants, 35% of the priests reported having a

strained relationship with their bishops, while 59% indicated that they received minimal

support from their bishops. They have also had problems with the management of the

church and received little support, further exacerbating their relationship with bishops

(Gautier et al., 2012).

Another type of occupational stressor that can lead to occupational stress for

Catholic clergy is perceived social isolation (Ford, 2017). Perceived isolation and

loneliness are prevalent among priests, even if their vocational roles allow them to be in

constant contact with others (Ford, 2017). Using secondary data from a clergy health

intervention collected by Duke University, Ford (2017) examined the relative effects of

various measures of social relationships on physical and mental health of a clergy

population (N = 616). The results were analyzed using a hierarchal multiple regression

using three phases to control for measures of perceived social relationships (i.e.,

relationship satisfaction, social isolation, social engagement, and social support), clergy

working environment (i.e., clergy works alone of with colleagues), and demographics.

After controlling for demographics, positive correlations were found between social

engagement and positive mental health/flourishing, life satisfaction, and ministry

satisfaction. A positive correlation between social isolation and depression was also

observed (Ford, 2017).

An 18-month evaluative study was conducted by Scott and Lovell (2015) with

rural pastors (N=51) to help them deal with occupational barriers (i.e., loneliness,

seclusion, stress, work-life imbalance, and an absence of self-care activities). Findings

showed that rural pastors suffered a significant degree of loneliness and isolation and that

pastors suffering from isolation reported difficulty in maintaining a healthy work-life

balance and experienced burnout. Consistent with other literature, people are more likely

to experience mental and physical health risks if they feel a higher degree of loneliness

(Cacioppo et al., 2006).

Milstein et al. (2019) examined the relationship between spiritual well-being,

occupational distress, and depressive symptoms in a longitudinal study that targeted a

sample of 895 United Methodist clergy. Researchers measured the potential relationships

among spiritual well-being, occupational distress, and depressive symptoms while

controlling for social support. The sample was composed of clergy who took part in both

the 2010 and 2011 Spirited Life surveys, labeled in the study as Time 1 and Time 2

(Milstein et al., 2019). These three variables were significantly correlated, where each

variable affected or depended on another during Time 1. The prospective effects between

Time 1 and Time 2, which was a year later, were then assessed using residualized change

linear regression models. Higher levels of spiritual well-being provided protection against

increases in depressive symptoms even when research iLimberlers controlled for

perceived emotional support. A longitudinal as well as directional pattern was observed

where lower spiritual well-being predicted higher levels of depressive symptoms which

in turn predicted higher levels of occupational distress (Milstein et al., 2019).

Clergy can experience instances of spiritual dryness that can cause occupational

distress associated with depression, poor psychological health, decreased work

engagement, and life dissatisfaction (Büssing et al., 2013). These authors defined

spiritual dryness as a situation in which clergy feel they lack a spiritual feeling or a

disconnection from God. Büssing et al. (2013) developed and tested the Spiritual Dryness

Scale using data from a sample of Catholic priests (N = 425). The findings showed that

40% of priests reported having experienced occasional spiritual dryness while 13%

experienced it regularly. Occupational factors such as low control over their duties,

devaluation by superiors, and work burden can impair the positive spiritual feelings that

priests are supposed to exhibit. Consequently, they can feel a sense of being abandoned

by God or a spiritual crisis leading to occupational stress (Büssing et al., 2013).

Social Support Among Clergy

Lin et al. (1979) described social support as the accessible support available from

individuals, groups, and communities due to their social ties. Others have defined it as the

individual's social network's support (i.e., emotional, instrumental, and informational)

that is available to help the individual cope with stress (Cohen, 2004). The stress-

buffering model is frequently used by researchers to explain the relationship between

social support and health outcomes (Proeschold‐Bell et al., 2015). This model allows

researchers to assess whether the perceived availability of social support buffers the

levels of stress and consequently improve its effects on well-being (Cohen & Wills,

1985).

Researchers have shown that having social support protects against the

detrimental impacts of stress on both mental and physical health (Cohen & Wills, 1985;

Szkody et al., 2021). Willis and Cohen (1985) found that a buffering effect (i.e., buffering

model) was present when the interpersonal resources (i.e., source of support) was

responsive to the specific needs elicited by the stressful situation. It was determined that

social support could only assist if it corresponds to the coping strategies suitable in a

stressful situation (Cohen & Wills, 1985). For example, if a supervisor is not being

supportive, it is unlikely that a buffering effect will be found between the social support

available and the effects of occupational stress or stressors.

Further research showed that there was a stronger correlation between perceived

social support and health outcomes than with actual support received (Cohen & Wills,

1985). This implies that when participants perceived that support was available, they

experienced improved mental and physical health outcomes even when actual support

was not offered. Because perceived social support is a difficult to define multifaceted,

complex concept, a specific agreed-upon definition has not been established (Nazari et

al., 2020); however, it is essential to understand the concept of perceived social support

and its impact on health. Researchers commonly describe it as the perceived availability,

adequacy, and quantity of different types of support (e.g., emotional, practical,

informational, and financial; Nazari et al., 2020). For example, studies have shown that

regardless of whether people receive the same levels of support, they may have different

perceptions of the support (e.g., amount, type, quality) they are receiving (Haber et al.,

2007).

In a qualitative descriptive study, Bricker and Fleischer (1993) explored the

experiences of perceived social support among a sample of Roman Catholic priests.

These researchers designed the qualitative descriptive study to understand perceptions of

feeling supported, identify the perceived sources, and comprehend what they classify as a

meaningful social support experience. The study showed that even when a priest has an

extensive network of social support available, it was perceived only as supplemental and

did not adequately compensate for occupational stressors. The researchers also found that

lack of intimacy and family, role expectations, and the instability of social support

sources as a result of mandatory transfers to be additional occupational stressors (Bricker

& Fleischer, 1993). The qualitative results of this study indicated that even if social

support is available from different sources throughout their social network, priests still

struggle with their perceptions of social support.

A study by Lee and Fung (2023) investigated the relationships between work-

family conflict (WFC), psychological distress, and well-being in Taiwanese clergy. The

sample consisted of 336 clergy members with a mean age of 46.1 years. The study

examined the four types of WFC (time-based work interference with family, time-based

family interference with work, strain-based work interference with family, and strain-

based family interference with work) and their associations with psychological distress

and well-being (life satisfaction, flourishing, and spiritual well-being). The results

showed that all four types of WFC were positively associated with psychological distress

and negatively associated with well-being. However, when modeled simultaneously, only

strain-based WFC was related to the outcomes. Furthermore, demographic factors such as

younger age, female gender, single status, working alone, and earning below the median

income were associated with higher levels of psychological distress and lower levels of

well-being (Lee & Fung, 2023). The study emphasizes the importance of stress-

management strategies among clergy to protect against burnout and promote positive

well-being. The authors suggest that structural interventions such as mentorship

programs, clergy support systems, and awareness of burnout and mental health needs can

be effective in promoting clergy mental health (Lee & Fung, 2023).

Somatic Symptoms and Health Among Clergy

A variety of studies have focused on the factors that affect the health of clergy

population. The focus of this section is on discussing studies that have been conducted on

elements of clergy life that affects their health. The section reviews somatic symptoms

and the influence they have on health. Somatic symptoms have been described as

discomforts such as headache, neck pain, chest pain, low back pain, and gastrointestinal

experienced by patients (Tsai, 2010). The presence of somatic symptoms has also been

described as somatization or somatic symptom disorder (D’Souza & Hooten, 2021).

Somatic symptoms have also been linked with the development of poor physical and

mental health outcomes such as cardiac dysfunction, pain, and other somatic health

complaints among patients (Penninx et al., 2013).

Proeschold-Bell and LeGrand (2012) conducted a quantitative study to examine

the physical health functioning (also known as health-related quality of life) among

United Methodist clergy compared to nonclergy population. The data collected in the

study showed that clergy exhibit significantly higher rates of chronic diseases in

comparison to their nonclergy counterparts. Such diseases include cancer, diabetes,

cardiovascular disease, and obesity. The rate of obesity among clergy aged between 35

and 64 years old was 39.7%, more than 10.3% greater than for their nonclergy

counterparts. This was attributed to work-related stress that worsened chronic illnesses.

For instance, the sample of clergy in the United Methodist church self-reported rates of

hypertension, arthritis, asthma, diabetes, and obesity; these were higher than the average

national rate. Health interventions are urgently needed to handle actual health outcomes

among clergy who are at risk of developing cancer, obesity, diabetes, and cardiovascular

diseases (Proeschold-Bell & LeGrand, 2012).

Webb et al. (2013) conducted a study to examine factors related to obesity among

the clergy (N=844), while controlling for physical activity and fruit and vegetable

consumption. Results showed that the clergy experienced a variety of chronic diseases,

with hypercholesterolemia (30%) and hypertension (29%) being the most common

diseases reported. The BMI measure of the clergy placed them into the obese (11%) and

overweight (38%) categories. These findings were comparable to those of the study by

Proeschold-Bell and LeGrand (2010) which used self-reported data from United

Methodist clergy to examine the prevalence of obesity among the clergy population

compared to nonclergy counterparts. The sample comprised 95% (N = 1726) of all

actively serving United Methodist clergy in North Carolina who completed the

Behavioral Risk Factor Surveillance Survey as well as self-reported weight and height

items.

The calculations of the BMI categories as well as the diagnosis prevalence rates

showed that the rate of obesity among clergy aged 35–64 years was 39.7% higher

compared to nonclergy counterparts. Further, the clergy population had higher diagnostic

rates for asthma, angina, high blood pressure, arthritis, and diabetes compared to the

nonclergy counterparts (Proeschold-Bell & LeGrand, 2010;Tice et al., 2021). The clergy

in the studie by Proeschold-Bell and LeGrand (2010) had a higher prevalence of obesity

compared to the national average (33%). The incidence of hypercholesterolemia shown in

Proeschold-Bell and LeGrand (2010) is alarming because it was twice the national

average (15%). A recent study examining the incidence of COVID-19 among priests

revealed that 39.8% of clergy were overweight, 52.2% were considered obese, 27.1%

were using anti-hypertensive medication, 23.5% were being treated for diabetes, 26.5%

were being treated for dyslipidemia, and 9.6% had a history of coronary artery disease

(Henein et al., 2021).

Harmon et al. (2021) explored the opportunities and resources for developing an

effective obesity-related program for clergy and their spouses. Qualitative methods,

including focus groups with 32 participants, were used to explore program targets,

opportunities and barriers that influence health behaviors, and empowering and culturally

relevant health promotion strategies. The study found that clergy health is a complex

issue influenced by various factors such as time constraints, traditions, and stress.

Participants reported struggling with stress, citing long work hours and emotional

demands as contributing factors. As discussed by Harmon et al. (2021), church traditions

can be a barrier to healthy behaviors among clergy and their spouses. Participants in the

study reported that the demands of their role as spiritual leaders often lead to neglect of

their personal health, including diet and exercise. Participants emphasized the need for

social support, particularly from peers who are going through similar experiences, and

spousal support, given the shared meals and lifestyles of spouses. The study findings

suggested that obesity-related programs should target the unique needs of both clergy and

spouses, focusing on healthy eating and personal connections, regardless of the modality

used. The study provides valuable insights into the challenges faced by clergy and their

spouses in adopting healthy behaviors and highlights the importance of tailored

interventions to address these challenges. The study highlight the complex factors that

influence clergy health, including time constraints, church traditions, and stress, and the

need for tailored interventions that address the specific needs of this population (Harmon

et al., 2021). Overall, the study underscores the importance of social support, spousal

support, and stress management tools in promoting healthy behaviors among clergy and

their spouses.

Adams et al. (2017) conducted a review of the quantitative literature, comparing

rates of burnout between clergy and other helping professions (e.g., social workers,

counselors, teachers, emergency personnel, and police). A total of 84 studies were used to

compare the score ranges of burnout among clergy (16 studies), social workers (13

studies), counselors (16 studies), teachers (22 studies), emergency personnel (7 studies),

police (10 studies), and MBI published mean norms. Compared to U.S. norms, the clergy

displayed moderate rates of burnout. There were three different aspects of burnout

studied in which the clergy had lower levels of burnout than police and emergency

personnel, comparable to social workers and teachers, and lower than counselors. The

three aspects of burnout measured using the Maslach Burnout Inventory were emotional

exhaustion, depersonalization, and personal accomplishment, with the clergy scoring

worse than professionals who worked as counselors. The researchers found that excessive

work expectations, excessive schedule demands, low social support, complicated

parishioners, and on-call shifts are external and systemic factors that promoted clergy

burnout.

Knox et al. (2002) analyzed data from a sample of 262 Roman Catholic clergy

residing in the United States to investigate the incidence of depression and anxiety

compared to a nonclergy sample. The results showed that depression levels among priests

in the diocese were seven times higher than the nonclergy. Additionally, rates of state

anxiety and trait anxiety were five to seven times greater than the general population. The

data also showed that low vocational satisfaction was a predictor of depression and low

social support was a predictor of trait anxiety. The sample of Catholic priests living with

other members of the clergy experienced moderate degrees of social support and were

satisfied with their vocation. The Catholic clergy who reported the highest degree of

burnout and depression reported lack of social support and sense of isolation as the key

contributing factors (Knox et al., 2002). According to the findings of other research, the

percentage of clergy who experience burnout might reach as high as 45% in some nations

(Jackson-Jordan, 2013). This is caused by the nature of their job as they are frequently

exposed to highly distressing news and situations in the course of discharging their duties

such as death of a member or a member’s loved one, distressed marriages, hospitalization

of a member and other forms of traumatic experiences (Proeschold-Bell et al., 2013).

A study was conducted on a sample of clergy in Florida to investigate

occupational distress, social support, mental health, and spiritual completeness using the

Patient Health Questionnaire (PHQ-9), the Clergy Occupational Distress Index (CODI),

and the Social Support Questionnaire Short Form (SSQ6) (Shaw et al., 2021). The entire

sample (N = 93) consisted of active clergy in Florida who were at least 18 years old and

not retired. The results of the study revealed that clergy had a depression rate of 12.9%,

which is worse than the previously self-reported rate of 11.1% among United Methodist

clergy study participants and the published national average for 2017 of 7.9%, as reported

by the CDC (National Institute of Mental Health, 2019; Proeschold-Bell et al., 2013;

Shaw et al., 2021). In addition, the research sample had greater occupational distress rates

than the published national mean averages. An inverse correlation was also show

between the SSQ6 and the PHQ-9 scores, such that higher levels of social support

available from greater numbers of sources were related to lower levels of depression

(Shaw et al., 2021). This adds to the limited body of evidence regarding the significance

of social support on the psychological well-being of clergy. A negative correlation

between years of ministry experience and PHQ-9 scores was also found (Shaw et al.,

2021). This indicates that those who have served in ministry for fewer years report higher

levels of depression than those who have served longer. This contradicts the findings of

prior studies, which revealed that longer amounts of time spent in ministry were

associated with greater levels of depression and anxiety (Proeschold-Bell et al., 2013;

Shaw et al., 2021).

Webb and Chase (2019) examined the association between occupational distress,

physical and mental health, and health behaviors among Christian clergy. The study

collected data from a convenience sample of 221 full-time clergy members who

completed a questionnaire comprising the Clergy Occupational Distress Index (CODI),

demographic, occupational, health, and behavioral variables. The study demonstrated that

elevated CODI scores were significantly associated with an increased risk of negative

health outcomes such as high blood pressure, diabetes, chronic stress disorder,

depression, anxiety, prolonged sitting time, and longer working hours per week.

Furthermore, the study suggested that occupational distress might negatively affect the

health of full-time Christian clergy, particularly those who are younger, and advocated

for further research on the temporal relationships among occupational distress, health,

and health behaviors among full-time clergy. In addition, the study revealed that found

that a significant proportion of clergy reported having chronic diseases such as high

blood pressure (33.5%), high cholesterol (29.0%), arthritis (15.4%), depression (14.9%),

anxiety (12.7%), and over half of the clergy were classified as obese. Logistic regression

models demonstrated that increasing age, BMI, and occupational distress were associated

with an increased likelihood of reporting a diagnosis of high blood pressure, high

cholesterol, type 2 diabetes, and arthritis. These findings suggested that the clergy might

be at a higher risk of negative health outcomes. Occupational distress was measured by

the CODI scale, with an average score of 11.5 (SD = 3.41), and the study found that

hours worked per week was a significant predictor of higher CODI scores, after

controlling for age and gender (Webb & Chase, 2019). logistic regression models

examining the effects of occupational distress on various health outcomes found that

increasing occupational distress was associated with an increased likelihood of reporting

a diagnosis of high blood pressure, type 2 diabetes, arthritis, and depression (Webb &

Chase, 2019).

Summary and Conclusions

While literature specific to Catholic clergy is limited, the literature from existing

studies suggests that this population experiences higher occupational stress, lower

perceived social support, and higher rates of chronic diseases compared to their

nonclergy counterparts. Being a preacher, pastor, teacher, administrator, counselor, and

organizer are some of the most common roles that involve highly diverse competencies

with numerous stressors. This chapter presented theories related to stress, social support,

and health. Different types of social support, including perceived organizational support

and perceived supervisor support, and how they reduce occupational stress and stressors

were also covered. Literature concerning the assessment of the relationship between

stress and its effects on health was also examined. The actual health outcome of clergy is

directly impacted by stress. Literature also shows a relationship between stress and

somatic symptoms, which can be indicators of poorer physical health status. Furthermore,

the extent to which perceived social support moderates the relationship between job-

related stress and somatic health symptoms among clergy has not been studied. Chapter 3

provides information on the research design and rationale, population, sampling,

recruitment, participation, and data collection procedures, threats to validity, and ethical

procedures.

Chapter 3: Research Method

Introduction

The purpose of this quantitative study was to determine the extent to which

perceived supervisor support and perceived organizational support moderate the

relationship between occupational distress (IV) and somatic symptoms (DV) among

Catholic clergy. In Chapter 3, I discuss the research design and rationale, population,

sampling and sampling procedures, procedures for recruitment, participation, data

collection, instrumentation and operationalization of constructs, threats to validity, and

ethical procedures.

Research Design and Rationale

This quantitative nonexperimental correlational study examined the extent to

which perceived supervisor support and perceived organizational support moderate the

relationship between occupational distress (IV) and somatic symptoms (DV) among

clergy. A correlational design was appropriate for this nonexperimental study to assess

and determine if a statistical relationship between the variables exists (Curtis et al., 2016).

A correlational design is a form of quantitative research consisting of the evaluation of

potential relationships between different variables. Therefore, the use of a correlational

design allows the use of scientific methods where different constructs are measured using

numbers to enhance the understanding of various phenomena.

For this study, occupational distress was the independent variable, somatic

symptoms was the dependent variable, and perceived supervisor support and perceived

organizational support were the moderators. A quantitative, nonexperimental approach

was used. Standard multiple regression analysis was used to analyze the data.

Methodology

Population

The population included priests of the Catholic church working in the United

States. For the purpose of this study, a priest were defined as a member of the clergy

ordained to the sacerdotal or pastoral office by the Catholic church. In 2020, there were

approximately 35,513 priests in the United States (Center for Applied Research in the

Apostolate [CARA], 2021). In the last 50 years, the total number of priests in the United

States decreased by 40%, from 59,192 in 1970 to 35,513 in 2020 (CARA, 2021; Lingier

& Vandewiele, 2021).

Sampling and Sampling Procedures

Convenience sampling, which is a nonprobability sampling technique, was the

sampling technique used to select the participants for this study. Participants were

recruited from various Facebook groups. The inclusion criteria for participation required

(a) the minimum age of 27, (b) being ordained as a priest by the Catholic church, (c)

having at least 2 years of experience as a priest, and (d) currently living in the United

States for a minimum of 3 years. The minimum age to participate was 27 because a

person needed at least 25 years of age to be ordained, and the inclusion criteria required 2

years of experience.

The recommended minimum sample size was determined using G*Power 3.1.9.7

software (Faul et al., 2009). The following parameters were used: an alpha level of .05,

five predictor variables, an anticipated effect size of .15, and statistical power of .80 to

determine the minimum recommended sample size. A medium effect size has been

reported in recent studies looking at the relationship between occupational stress and

illness or disease among clergy (Proeschold-Bell & LeGrand, 2012). However,

moderations tend to have small effect sizes, so an effect size of .05 was used for the

moderators. The five predictor variables were occupational distress, perceived supervisor

support, perceived organizational support, and the interaction variables (supervisor

support and occupational distress, organizational support and organizational support).

The results of the power analysis indicated a recommended sample size of 196

participants.

Procedures for Recruitment, Participation, and Data Collection

After the study was approved by the Walden Institutional Review Board (IRB),

participants were recruited from various public Facebook groups and individual clergy

members were contacted via email using addresses obtained from the 2022 Official

Catholic Directory. A recruitment post was made with the approval of the group

administrator that provided an explanation of the study and a hyperlink to the survey

hosted by Microsoft Forms. This same hyperlink was included in the recruitment email.

Before accessing the online survey, participants were directed to an informed consent

form that required their consent. The purpose of the study, disclosure for voluntary

participation, and the ethical considerations related to the present study were included in

the informed consent. Participants were also informed that they could withdraw their data

at any point throughout the survey, providing them with the opportunity to discontinue

for any reason. To maintain data integrity, all survey questions had a validation feature,

requiring participants to respond to every question to prevent missing data.

Instrumentation and Operationalization of Constructs

Clergy Occupational Distress Index

Occupational distress was measured with the Clergy Occupational Distress Index

(CODI; Frenk et al., 2013). The CODI is a five-item index designed to measure the

participant's occupational distress by assessing their perceptions of their occupational

demands and how often they have experienced a stressful situation over the past year due

to their occupation (Frenk et al., 2013). The 5-items measure the adverse impact that

occupational distress has on the health, career, and the quality of the clergy's

congregational work (Frenk et al., 2013). The five items include the following: "During

the past year, how often have the people in your congregation made too many demands of

you?"; "During the past year, how often have the people in your congregation been

critical of you and the things you have done?"; "Looking back over the past year, how

often have you experienced stress as a result of dealing with congregational members

who are critical of you?"; "Over the past year, how often have you felt lonely or isolated

in your work?"; and "Over the past year, how often have you experienced stress because

of the challenges you have in this congregation?" Participants respond to each item using

a 4-point Likert scale: 1 = never, 2 = once in a while, 3 = fairly often, and 4 = very often

(Frenk et al., 2013). The total score could range from 5 to 20.

Reliability and Validity. In the study conducted by Frenk et al. (2013), the

reliability and validity of the CODI was assessed by using the data from two samples of

data. The data used came from a nationally representative sample of clergy (Pulpit and

Pew National Survey of Pastoral Leaders) and a sample of clergy from nine Protestant

denominations (Church Benefits Association; Frenk et al., 2013). Specifically, the

nationally representative sample was used for construct validity assessment. A high

internal consistency was observed in two samples with Cronbach's alpha values of 0.77 in

the Pulpit and Pew sample and 0.82 in the Church Benefits Association sample (Frenk et

al., 2013).

Construct validity was assessed by examining the relationship between scores on

the CODI and symptoms of depression experienced during the previous 4 weeks (Frenk

et al., 2013). An ordinary least squares (OLS) regression model was used to achieve this.

The OLS regression model allowed the authors to evaluate the statistical association

between the dependent variable and the a measure of depressive mood during the last 4

weeks, while controlling for demographic, ministerial, and health variables (Frenk et al.,

2013). The OLS regression model's results show that there was a significant and positive

association between the CODI and depressive symptoms with a robust coefficient (p <

0.001; Frenk et al., 2013). Occupational distress was a significant predictor of depressive

symptoms. The authors conducted the exploratory factor analysis on the CODI items of

demand, criticism, stress from criticism, loneliness, and stress from challenges on each of

the two samples. In the Pulpit and Pew sample, the eigenvalues for the single factor for

occupational distress for the five items ranged from 0.65 to 0.81 (Frenk et al., 2013). For

the Church Benefits Association samples, eigenvalues for the single factor for

occupational distress for the five items ranged from 0.67 to 0.84 (Frenk et al., 2013). The

factor analysis demonstrated construct validity for the five items resulting in a single

factor or total score of clergy occupational distress.

Physical Health Questionnaire

Somatic symptoms were measured with the Physical Health Questionnaire (PHQ-

14; Schat et al., 2005). The PHQ-14 is a revised 14-item index (originally 32 items)

designed to measure somatic symptoms (Schat et al., 2005). The scale is composed of 14

items relating to how frequently participants experience sleep disturbances, headaches,

respiratory problems, and gastrointestinal problems, each of which is a subscale of the

PHQ-14 (Schat et al., 2005). The frequency of somatic health issues among participants

is measured by the PHQ-14, which allows for analysis using its individual subscales or a

singular overall somatic health index (Schat & Kelloway, 2003). Example items include

"How often have you had difficulty getting to sleep at night?" and "How often have you

suffered from an upset stomach (indigestion)?" Eleven of the items are answered using a

Likert-type rating, ranging from 1 (not at all) to 7 (all of the time). For the other three,

two are answered using a range of 0 to 7+ times, and one is answered using a range of 1

day to 7 days. Before analyzing the data, all items need to be reverse coded except Item 4

so that a greater mean score will reflect greater somatic health problems (Schat et al.,

2005).

Reliability and Validity. Schat et al. (2005) conducted several studies to examine

the psychometric properties of the PHQ. The first study used a sample of 194 staff

members from a hospital in Ontario to provide an initial assessment of validity by

performing exploratory factor analysis on the PHQ items (Schat et al., 2005). It was

confirmed that the PHQ is a psychometrically sound instrument with revealed

Cronbach’s alpha of .83, .88, .80, and .66 for each of the subscales (gastrointestinal

problems, headaches, sleep disturbance, and respiratory infections; Schat et al., 2005).

Schat et al. (2005) evaluated measurement invariance and offered tests to provide

evidence of the construct validity of the four subscales of the PHQ (gastrointestinal

problems, headaches, sleep disturbance, and respiratory infections). Principal components

extraction with varimax rotation was performed, and four factors were extracted

(gastrointestinal problems, headaches, sleep disturbance, and respiratory infections) that

cumulatively explained 68.9% of the item variance (Schat et al., 2005).

The four items that measure the frequency of sleep disturbance had eigenvalues

ranging from .56 to .85 (Schat et al., 2005). The three items that measure the frequency of

headaches had eigenvalues that ranged from .82 to .89 (Schat et al., 2005). The four items

that measure the frequency of gastrointestinal problems had eigenvalues that ranged from

.63 to .90 (Schat et al., 2005). Finally, the three items that measure the frequency of

respiratory infections had eigenvalues ranging from .72 to .79 (Schat et al., 2005).

Evidence for convergent validity was supported by the standardized parameter estimates

representing the association between negative affect (predictor variable) and the PHQ

subscales scores (outcome variable; Schat et al., 2005). The scores for negative affect

were a significant predictor for sleep disturbance (β = .47), headaches (β = .33),

gastrointestinal problems (β = .38), and respiratory illness (β = .39; Schat et al., 2005).

Schat et al. (2005) assessed discriminant validity by looking at the relationship

between PHQ subscale scores and job performance with two samples of participants. The

correlations between PHQ and job performance for the two samples were .10 and .002 for

gastrointestinal problems, .06 and .04 for headaches, .05 and .001 for sleep disturbance,

and .09 and .12 for respiratory infections (Schat et al., 2005). The PHQ demonstrated

discriminant validity due to the lack of significant correlations. Schat et al. (2005)

identified the internal consistency reliability for the four PHQ subscales using Sample 1

and 2 and obtaining the Cronbach’s alpha values of .84 and .86 for the gastrointestinal

problems subscale, .84 and .86 for the headaches subscale, .79 and .84 for the sleep

disturbance subscale, and .66 and .61 for the respiratory infections subscale.

Survey of Perceived Organizational Support

Perceived organizational support was measured with the Survey of Perceived

Organizational Support (SPOS), a revised eight-item index (originally 36 items) designed

and modified by Eisenberger and others (Eisenberger et al., 1986; Shanock &

Eisenberger, 2006). The initial SPOS contained 36 items with a Cronbach’s alpha of α =

.97 (Eisenberger et al., 1986). However, a shorter eight-item version of the scale was

developed following the recommendations of Rhoades and Eisenberger (2002). The

original 36-item scale was unidimensional and had high internal reliability; a meta-

analysis of existing research literature that used the SPOS found no issues if the shorter

version was used (Eisenberger et al., 2002). Example items include "The organization

values my contribution to its well-being” and "The organization appreciates any extra

effort from me” (Eisenberger et al., 1986, 2002). The eight items of the scale are

answered using a 7-point Likert-type response, ranging from 0 (strongly disagree) to 6

(strongly agree; Eisenberger et al., 1986, 2002). The SPOS was designed to provide a

total perceived organizational status score.

Reliability and Validity. Internal consistency was reported for the original 36-

item scale with a reliability coefficient (Cronbach's alpha) of .97 (Eisenberger et al.,

1986). Rhoades and Eisenberger (2002) conducted a meta-analysis of 73 independent

studies from different industries and found a high internal reliability for SPOS (average

Cronbach's alpha of .90). Eisenberger (2002) assessed the reliability and validity of the

eight-item version of the SPOS, which was used in the present study, using the data from

two samples of data. The data used came from a sample that consisted of 314 alumni of a

Belgian university that took part of three studies assessing the relationships among

employees’ perception of supervisor support (PSS), perceived organizational support

(POS), and employee turnover (Eisenberger et al., 2002). A high internal consistency was

observed at two different times, with Cronbach's alpha values of 0.74 at Time 1 and 0.75

at Time 2 (Eisenberger et al., 2002). The eight-item version of the SPOS was previously

used by Worley et al. (2009) in a study that involved 450 U.S. community college

employees. It was also used by Mansoor et al. (2010) in a study that involved bank

employees. It was also used by Bailey (2014) in a study that focused on hospital staff.

The study by Worley et al. showed adequate internal reliability consistency with an alpha

reliability coefficient of 0.93. The study by Mansoor et al. (2010) revealed an alpha

reliability coefficient of 0.96. Bailey achieved an internal coefficient of 0.91.

Kurtessis et al. (2017) conducted a meta-analytic evaluation that included 492

papers containing 558 research studies focused on organizational support. In his meta-

analysis, the SPOS had a convergent validity with affective commitment (r = .42, p <

.001), organizational identification (r = .44, p < .001), and intention to stay in

organization (r = .48, p < .001).

Survey of Perceived Supervisory Support

Supervisor support was measured with the Survey of Perceived Supervisor

Support (Shanock & Eisenberger, 2006). The Survey of Perceived Supervisor Support is

an eight-item scale that measures perceived supervisor support using a 7-point Likert-

type response format, ranging from 0 (strongly disagree) to 6 (strongly agree). This

survey was developed following Shanock and Eisenberger's recommendations to use the

SPOS and replace the word "organization" with "supervisor" (Eisenberger et al., 2002;

Shanock & Eisenberger, 2006). The survey items include statements such as "The

supervisor values my contribution to its well-being" and "The supervisor appreciates any

extra effort from me.” The eight items of the scale are answered using a 7-point Likert-

type response format, ranging from 0 (strongly disagree) to 6 (strongly agree)

(Eisenberger et al., 1986, 2002). It provides a total score that ranges from 0 to 56.

Reliability and Validity. Eisenberger (2002) assessed the reliability and validity

of the eight-item version of the SPSS, which was used in the present study, using the data

from two samples of data. The data used came from a sample that consisted of 314

alumni of a Belgian university which took part of three studies assessing the relationships

among employees’ perception of supervisor support (PSS), perceived organizational

support (POS), and employee turnover (Eisenberger et al., 2002). A high internal

consistency was observed at two different times, with Cronbach's alpha values of 0.81 at

Time 1 and 0.82 at Time 2 (Eisenberger et al., 2002). Several researchers have also used

this scale and found it to be reliable, with a Cronbach's alpha ranging from .93 to .95

(Igbaria & Wormley, 1992; Jayaweera, 2010; Kurlansik & Maffei, 2016). The eight-item

version of the modified Survey of Perceived Supervisor Support exhibited high internal

consistency with a Cronbach's alpha of .91 for nursing supervisors and .948 for school

supervisors (Sharma et al., 2021).

The authors examined the factor loading estimates and found that not all loadings

were highly significant for this study. As suggested by Hair (2009), to obtain convergent

validity factor loadings need to at least be .5 but preferably.7. Once the highly significant

items were adjusted, the moderate fit to the data was: χ2 (59) = 95.95, p <.05, CFI =.98,

RMSEA =.05. This enabled the researchers to establish convergent validity since the

factor loadings of all items were all higher than.7, were statistically significant (p <.05),

and all the average variance extracted (AVE) estimates were higher than the

recommended value of .5 (Bagozzi & Yi, 1988).

Research Questions and Hypotheses

RQ1: To what extent does occupational distress, as measured by the Clergy

Occupational Distress Index, relate to somatic health symptoms (gastrointestinal

problems, headaches, sleep disturbance, and respiratory infections), as measured by the

Physical Health Questionnaire, among Catholic clergy working in the United States?

H01: Occupational distress is not a significant predictor of somatic health

symptoms (gastrointestinal problems, headaches, sleep disturbance, and respiratory

infections).