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01-12-2013 | Original Paper

Using Effort-Reward Imbalance Theory to Understand High Rates of Depression and Anxiety Among Clergy

Authors: Rae Jean Proeschold-Bell, Andrew Miles, Matthew Toth, Christopher Adams, Bruce W. Smith, David Toole

Published in: Journal of Prevention | Issue 6/2013

Abstract

The clergy occupation is unique in its combination of role strains and higher calling, putting clergy mental health at risk. We surveyed all United Methodist clergy in North Carolina, and 95 % (n = 1,726) responded, with 38% responding via phone interview. We compared clergy phone interview depression rates, assessed using the Patient Health Questionnaire (PHQ-9), to those of in-person interviews in a representative United States sample that also used the PHQ-9. The clergy depression prevalence was 8.7 %, significantly higher than the 5.5 % rate of the national sample. We used logistic regression to explain depression, and also anxiety, assessed using the Hospital Anxiety and Depression Scale. As hypothesized by effort-reward imbalance theory, several extrinsic demands (job stress, life unpredictability) and intrinsic demands (guilt about not doing enough work, doubting one’s call to ministry) significantly predicted depression and anxiety, as did rewards such as ministry satisfaction and lack of financial stress. The high rate of clergy depression signals the need for preventive policies and programs for clergy. The extrinsic and intrinsic demands and rewards suggest specific actions to improve clergy mental health.

Andrade, L., Caraveo-Anduaga, J. J., Berglund, P., Bijl, R. V., DeGraaf, R., Vollebergh, W., et al. (2003). The epidemiology of major depressive episodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. International Journal of Methods in Psychiatric Research, 12(1), 3–21.PubMedCrossRef

Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52, 69–77.PubMedCrossRef

Blanton, P. W., & Morris, M. L. (1999). Work-related predictors of physical symptomatology and emotional well-being among clergy and spouses. Review of Religious Research, 40(4), 331–348.CrossRef

Blizzard, S. W. (1956). The minister’s dilemma. Christian Century, 73, 508–510.

Bohnert, A. S. B., Perron, B. E., Jarman, C. N., Vaughn, M. G., Chatters, L. M., & Taylor, R. J. (2010). Use of clergy services among individuals seeking treatment for alcohol use problems. American Journal of Addictions, 19, 345–351.

Bowling, A. (2005). Mode of questionnaire administration can have serious effects on data quality. Journal of Public Health, 27(3), 281–291.PubMedCrossRef

Campbell, D. M. (1994). The call to ordained ministry. Who will go for us? An invitation to ordained ministry (pp. 26–59). Nashville: Abingdon Press.

Carroll, J. W. (2006). God’s potters: Pastoral leadership and the shaping of congregations. Grand Rapids: William B. Eerdmans Pub.

Cartwright, S., & Cooper, C. C. (Eds.). (2008). The Oxford handbook of organizational well-being. Oxford: Oxford University Press.

Centers for Disease Control and Prevention. (2013). National Health and Nutrition Examination Survey. Retrieved July 29, 2013, from http://www.cdc.gov/nchs/nhanes.htm.

Chatters, L. M., Mattis, J. S., Woodward, A. T., Taylor, R. J., Neighbors, H. W., & Grayman, N. A. (2011). Use of ministers for a serious personal problem among African Americans: Findings from the National Survey of American Life. American Journal of Orthopsychiatry, 81(1), 118–127.PubMedCrossRef

Cohen, F. (1984). Coping. In J. D. Matarazzo, S. M. Weiss, J. A. Herd, N. E. Miller, & S. M. Weiss (Eds.), Behavioral health: A handbook of health enhancement and disease prevention. New York: Wiley.

Crawford, J. R., Henry, J. D., Crombie, C., & Taylor, E. P. (2001). Normative data for the HADS from a large non-clinical sample. British Journal of Clinical Psychology, 40, 429–434.PubMedCrossRef

Daly, E. J., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Gaynes, B. N., Warden, D., et al. (2010). Health-related quality of life in depression: A STAR*D report. Annals of Clinical Psychiatry, 22(1), 43–55.PubMed

Darling, C. A., Hill, E. W., & McWey, L. M. (2004). Understanding stress and quality of life for clergy and clergy spouses. Stress & Health: Journal of the International Society for the Investigation of Stress, 20(5), 261–277.CrossRef

Dewe, P. J. (1987). New Zealand ministers of religion: Identifying sources of stress and coping strategies. Work and Stress, 1(4), 351–363.CrossRef

Eysenck, H. J., Barrett, P., Wilson, G., & Jackson, C. (1992). Primary trait measurement of the 21 components of the P-E-N system. European Journal of Psychological Assessment, 8(2), 109–117.

Ferris, P. A., Kline, T. J. B., & Bourdage, J. S. (2012). He said, she said: Work, biopsychosocial, and lifestyle contributions to coronary heart disease risk. Health Psychology, 31(4), 503–511. doi:10.1037/a0026394.PubMedCrossRef

Finke, R., & Dougherty, K. D. (2002). The effects of professional training: The social and religious capital acquired in seminaries. Journal for the Scientific Study of Religion, 41(1), 103–120.CrossRef

Frame, M. W., & Shehan, C. L. (1994). Work and well-being in the two-person career: Relocation stress and coping among clergy husbands and wives. Family Relations, 43(2), 196–205.CrossRef

Frenk, S. M., Mustillo, S. A., Hooten, E. G., & Meador, K. G. (2011). The Clergy Occupational Distress Index (CODI): Background and findings from two samples of clergy. Journal of Religion and Health,. doi:10.1007/s10943-011-9486-4.PubMed

Glanz, K., & Schwartz, M. D. (2008). Stress, coping, and health behavior. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research and practice (4th ed., pp. 211–236). San Francisco: Jossey-Bass.

Gleason, J. J. (1977). Perception of stress among clergy and their spouses. The Journal of Pastoral Care, 31, 448–452.

Grosch, W. N., & Olson, D. C. (2000). Clergy burnout: An integrative approach. Journal of Clinical Psychology, 56(5), 619–632.PubMedCrossRef

Jones, S. H., Francis, L. J., & Jackson, C. (2004). The relationship between religion and anxiety: A study among Anglican clergymen and clergywomen. Journal of Psychology & Theology, 32(2), 137–142.

Kay, W. K. (2000). Role conflict and British Pentecostal ministers. Journal of Pyschology and Theology, 28(2), 119–124.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., et al. (2003). The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association, 289(23), 3095–3105. doi:10.1001/jama.289.23.3095.PubMedCrossRef

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.PubMedCrossRef

Klinkman, M. S., Coyne, J. C., Gallo, S., & Schwenk, T. L. (1997). Can case-finding instruments be used to improve physician detection of depression in primary care? Archives of Family Medicine, 6(6), 567–573.PubMedCrossRef

Knox, S., Virginia, S. G., & Lombardo, J. P. (2002). Depression and anxiety in Roman Catholic secular clergy. Pastoral Psychology, 50(5), 345–358.CrossRef

Knox, S., Virginia, S. G., & Smith, J. (2007). Pilot study of psychopathology among Roman Catholic secular clergy. Pastoral Psychology, 55(3), 297–306.CrossRef

Knox, S., Virginia, S. G., Thull, J., & Lombardo, J. P. (2005). Depression and contributors to vocational satisfaction in Roman Catholic secular clergy. Pastoral Psychology, 54(2), 139–153.CrossRef

Krause, N., Ellison, C. G., & Wulff, K. M. (1998). Church-based emotional support, negative interaction, and psychological well-being: Findings from a national sample of Presbyterians. Journal for the Scientific Study of Religion, 37(4), 725–741.CrossRef

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.PubMedCrossRef

Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317–325.PubMedCrossRef

Kuhne, G. W., & Donaldson, J. F. (1995). Balancing ministry and management: An exploratory study of pastoral work activities. Review of Religious Research, 37(2), 147–163.CrossRef

Lagerveld, S. E., Bültmann, U. U., Franche, R. L., van Dijk, F. H., Vlasveld, M. C., van der Feltz-Cornelis, C. M., et al. (2010). Factors associated with work participation and work functioning in depressed workers: A systematic review. Journal of Occupational Rehabilitation, 20(3), 275–292. doi:10.1007/s10926-009-9224-x.PubMedCrossRef

Lee, C., & Iverson-Gilbert, J. (2003). Demand, support, and perception in family-related stress among Protestant clergy. Family Relations, 52(3), 249–257.CrossRef

Lerner, D., Adler, D. A., Rogers, W. H., Chang, H., Lapitsky, L., McLaughlin, T., et al. (2010). Work performance of employees with depression: The impact of work stressors. American Journal of Health Promotion, 24(3), 205–213.PubMedCrossRef

Lerner, D., & Henke, R. (2008). What does research tell us about depression, job performance, and work productivity? Journal of Occupational and Environmental Medicine, 50(4), 401–410.PubMedCrossRef

Mendlowicz, M. V., & Stein, M. B. (2000). Quality of life in individuals with anxiety disorders. American Journal of Psychiatry, 157(5), 669–682. doi:10.1176/appi.ajp.157.5.669.PubMedCrossRef

Miles, A., & Proeschold-Bell, R. J. (2012). Are rural clergy worse off? An examination of occupational conditions and pastoral experiences in a sample of United Methodist clergy. Sociology of Religion: A Quarterly Review, 73(1), 23–45. doi:10.1093/socrel/srr025.CrossRef

Milstein, G., Kennedy, G. J., Bruce, M. L., Flannelly, K., Chelchowski, N., & Bone, L. (2005). The clergy’s role in reducing stigma: Elder patients’ views. World Psychiatry, 4(S1), 26–32.

Mirowsky, J., & Ross, C. E. (1992). Age and depression. Journal of Health and Social Behavior, 33(3), 187–205.PubMedCrossRef

Morris, M. L., & Blanton, P. (1998). Predictors of family functioning among clergy and spouses: Influences of social context and perceptions of work-related stressors. Journal of Child and Family Studies, 7, 27–41.CrossRef

Musson, D. J. (1998). The personality profile of male Anglican clergy in England: The 16PF. Personality and Individual Differences, 25(4), 689–698.CrossRef

National Center for Health Statistics. (2012). Prevalence of current depression among persons aged ≥ 12 years, by age group and sex—United States, National Health and Nutrition Examination Survey, 2007–2010. Morbidity and Mortality Weekly Report, 60(51, 52), 1747.

Niebuhr, H. R. (1957). The purpose of the church and its ministry. New York: Harper & Row.

Noller, P. (1984). Clergy marriages: A study of a uniting church sample. Austrailian Journal of Sex, Marriage and Family, 5, 187–197.

Pallone, N., & Banks, R. (1968). Vocational satisfaction among ministerial students. Personnal & Guidance Journal, 46, 870–875.CrossRef

Pargament, K. I., & Mahoney, A. (2005). Theory: Sacred matters: Sanctification as a vital topic for the psychology of religion. International Journal for the Psychology of Religion, 15(3), 179–198.CrossRef

Peirce, R. S., Frone, M. R., Russell, M., & Cooper, M. L. (1994). Relationship of financial strain and psychosocial resources to alcohol use and abuse: The mediating role of negative affect and drinking motives. Journal of Health and Social Behavior, 35(4), 291–308.PubMedCrossRef

Perl, P., & Chang, P. M. Y. (2000). Credentialism across creeds: Clergy education and stratification in protestant denominations. Journal for the Scientific Study of Religion, 39(2), 171–188.CrossRef

Pratt, L. A., & Brody, D. J. (2008). Depression in the United States household population, 2005–2006. NCHS Data Brief, 7, 1–7.PubMed

Proulx, W. A. (2008). Depressive symptoms among members of the clergy serving on the New Mexico district of the Church of the Nazarene in the United States. Dissertation Abstracts International Section A: Humanities and Social Sciences, 69(6-A), 2315.

R Development Core Team. (2011). R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing.

Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.CrossRef

Rayburn, C. A., Richmond, L. J., & Rogers, L. (1986). Men, women, and religion: Stress within leadership roles. Journal of Clinical Psychology, 42(3), 540–546.PubMedCrossRef

Schnall, P. L., Dobson, M., Rosskam, E., Baker, D., & Landsbergis, P. (Eds.). (2008). Unhealthy work: Causes, consequences and cures. Amityville: Baywood Press.

Shirom, A., Toker, S., Alkaly, Y., Jacobson, O., & Balicer, R. (2011). Work-based predictors of mortality: A 20-year follow-up of healthy employees. Health Psychology, 30(3), 268–275.PubMedCrossRef

Siegrist, J. (1996). Adverse health effects of high effort/low-reward conditions. Journal of Occupational Health Psychology, 1(1), 27–41.PubMedCrossRef

Siegrist, J., & Matschinger, H. (1989). Restricted status control and cardiovascular risk. In A. Steptoe & A. Appels (Eds.), Stress, personal control and health (pp. 65–82). Chichester: Wiley.

Spielberger, C. D., Gorsuch, R. L., Lushene, P. R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the state-trait anxiety inventory (Form Y). Palo Alto: Consulting Psychologists Press, Inc.

Spitzer, R. L., Kroenke, K., Williams, J. B., & The Patient Health Questionnaire Primary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Journal of the American Medical Association, 282(18), 1737–1744.

Stewart-Sicking, J. A. (2012). Subjective well-being among Episcopal priests: Predictors and comparisons to non-clinical norms. Journal of Prevention & Intervention in the Community, 40(3), 180–193.

Stewart-Sicking, J. A., Ciarrocchi, J. W., Hollensbe, E. C., & Sheep, M. L. (2011). Workplace characteristics, career/vocation satisfaction, and existential well-being in Episcopal clergy. Mental Health, Religion & Culture, 14(7), 715–730.CrossRef

Stordal, E., Krüger, M. B., Dahl, N. H., Krüger, Ø., Mykletun, A., & Dahl, A. A. (2001). Depression in relation to age and gender in the general population: The Nord-Trøndelag Health Study (HUNT). Acta Psychiatrica Scandinavica, 104(3), 210–216.PubMedCrossRef

SUDAAN. (2008). SUDAAN Release 10. RTP: RTI International.

US Department of Labor. (2012). Occupational outlook handbook, 2012–2013 edition. Retrieved April 25, 2012, from http://www.bls.gov/ooh/home.htm.

US Department of Labor. (2013). Employment projections: Education and training. Retrieved April 3, 2013, from http://www.bls.gov/emp/ep_chart_001.htm.

Wang, P. S., Berglund, P. A., & Kessler, R. C. (2003). Patterns and correlates of contacting clergy for mental disorders in the United States. Health Services Research, 38(2), 647–673.PubMedCrossRef

Weaver, A. J. (1995). Has there been a failure to prepare and support parish-based clergy in their role as front-line community mental health workers? A review. The Journal of Pastoral Care, 49, 129–149.

Weaver, A. J., Larson, D., Flannelly, K., Stapleton, C., & Koenig, H. (2002). Mental health issues among clergy and other religious professionals: A review of research. The Journal of Pastoral Care & Counseling, 56, 393–403.

Weiner, H. (1992). Perturbing the organism: The biology of stressful experience. Chicago: Chicago University Press.

Wong, M., Sakisian, C., Davis, C., Kinsler, J., & Cunningham, W. (2006). The association between life chaos, health care use, and health status among HIV-infected persons. Journal of General Internal Medicine, 22, 1286–1291.CrossRef

Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.PubMedCrossRef

Title: Using Effort-Reward Imbalance Theory to Understand High Rates of Depression and Anxiety Among Clergy
Authors: Rae Jean Proeschold-Bell
Andrew Miles
Matthew Toth
Christopher Adams
Bruce W. Smith
David Toole
Publication date: 01-12-2013
Publisher: Springer US
Published in: Journal of Prevention / Issue 6/2013
Print ISSN: 2731-5533
Electronic ISSN: 2731-5541
DOI: https://doi.org/10.1007/s10935-013-0321-4

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Using Effort-Reward Imbalance Theory to Understand High Rates of Depression and Anxiety Among Clergy

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