# ind_items

title_index: multicultural-and-social-justice-counseling-competencies
full_text_index:
       multicultural and social justice counseling competencies  developed by the multicultural counseling competencies revisions committee: dr. manivong j. ratts, chair (seattle university) dr. anneliese a. singh (university of georgia) dr. sylvia nassar-mcmillan (north carolina state university), dr. s. kent butler (university of central florida) julian rafferty mccullough (georgia state university)  appointed by dr. carlos hipolito-delgado president, association for multicultural counseling and development (2014-2015)  endorsed on june 29, 2015 by association for multicultural counseling and development executive council a division of the american counseling association  endorsed on july 20, 2015 by american counseling association governing council    2 table of contents  1. overview..........................................................................................3 2. multicultural and social justice counseling competencies conceptual framework...4 3. multicultural and social justice counseling competencies.............................5-14    3 multicultural and social justice counseling competencies the multicultural and social justice counseling competencies (msjcc), which  revises the multicultural counseling competencies (mcc) developed by sue, arredondo, and mcdavis (1992) offers counselors a framework to implement multicultural and social justice competencies into counseling theories, practices, and research. a conceptual framework (see figure 1) of the msjcc is provided to illustrate a visual map of the relationship between the constructs and competencies being articulated within the msjcc. moreover, quadrants are used to highlight the intersection of identities and the dynamics of power, privilege, and oppression that influence the counseling relationship. developmental domains reflect the different layers that lead to multicultural and social justice competence: (1) counselor self-awareness, (2) client worldview, (3) counseling relationship, and (4) counseling and advocacy interventions. embedded within the first three developmental domains of the msjcc are the following aspirational competencies: attitudes and beliefs, knowledge, skills, and action (aksa). the socioecological model is incorporated within the counseling and advocacy interventions domain to provide counselors a multilevel framework for individual counseling and social justice advocacy.    4 figure 1 multicultural and social justice counseling competencies  figure 1: multicultural and social justice counseling competencies retrieved from http://www.counseling.org/knowledge-center/competencies. copyright 2015 by m.j. ratts, a.a. singh, s. nassar-mcmillan, s.k. butler, & j.r. mccullough. reprinted with permission.    5 multicultural and social justice counseling competencies  i. counselor self-awareness privileged and marginalized counselors develop self-awareness, so that they may explore their attitudes and beliefs, develop knowledge, skills, and action relative to their self-awareness and worldview. 1. attitudes and beliefs: privileged and marginalized counselors are aware of their social identities, social group statuses, power, privilege, oppression, strengths, limitations, assumptions, attitudes, values, beliefs, and biases. multicultural and social justice competent counselors: • acknowledge their assumptions, worldviews, values, beliefs, and biases as members of privileged and marginalized groups. • acknowledge their privileged and marginalized status in society. • acknowledge their privileged and marginalized status influences their worldview. • acknowledge their privileged and marginalized status provides advantages and disadvantages in society. • acknowledge openness to learning about their cultural background as well as their privileged and marginalized status. 2. knowledge: privileged and marginalized counselors possess an understanding of their social identities, social group statuses, power, privilege, oppression, strengths, limitations, assumptions, attitudes, values, beliefs, and biases. multicultural and social justice competent counselors: • develop knowledge of resources to become aware of their assumptions, worldviews, values, beliefs, biases, and privileged and marginalized status. • develop knowledge about the history and events that shape their privileged and marginalized status. • develop knowledge of theories that explain how their privileged and marginalized status influences their experiences and worldview. • develop knowledge of how their privileged and marginalized status leads to advantages and disadvantages in society. 3. skills: privileged and marginalized counselors possess skills that enrich their understanding of their social identities, social group statuses, power, privilege, oppression, limitations, assumptions, attitudes, values, beliefs, and biases. multicultural and social justice competent counselors: • acquire reflective and critical thinking skills to gain insight into their assumptions, worldviews, values, beliefs, biases, and privileged and marginalized status.    6 • • • •  acquire communication skills to explain how their privileged and marginalized status influences their worldview and experiences. acquire application skills to interpret knowledge of their privileged and marginalized status in personal and professional settings. acquire analytical skills to compare and contrast their privileged and marginalized status and experiences to others. acquire evaluation skills to assess the degree to which their privileged and marginalized status influences their personal and professional experiences.  4. action: privileged and marginalized counselors take action to increase selfawareness of their social identities, social group statuses, power, privilege, oppression, strengths, limitations, assumptions, attitudes, values, beliefs, and biases. multicultural and social justice competent counselors: • take action to learn about their assumptions, worldviews, values, beliefs, biases, and culture as a member of a privileged and marginalized group. • take action to seek out professional development opportunities to learn more about themselves as a member of a privileged or marginalized group. • take action to immerse themselves in their community to learn about how power, privilege, and oppression influence their privileged and marginalized experiences. • take action to learn about how their communication style is influenced by their privileged and marginalized status. ii. client worldview privileged and marginalized counselors are aware, knowledgeable, skilled, and action-oriented in understanding clients’ worldview. 1. attitudes and beliefs: privileged and marginalized counselors are aware of clients’ worldview, assumptions, attitudes, values, beliefs, biases, social identities, social group statuses, and experiences with power, privilege, and oppression. multicultural and social justice competent counselors: • acknowledge a need to possess a curiosity for privileged and marginalized clients’ history, worldview, cultural background, values, beliefs, biases, and experiences. • acknowledge that identity development influences the worldviews and lived experiences of privileged and marginalized clients. • acknowledge their strengths and limitations in working with clients from privileged and marginalized groups. • acknowledge that learning about privileged and marginalized clients may sometimes be an uncomfortable or unfamiliar experience.    7 • • • •  acknowledge that learning about clients’ privileged and marginalized status is a lifelong endeavor. acknowledge the importance of reflecting on the attitudes, beliefs, prejudices, and biases they hold about privileged and marginalized clients. acknowledge that there are within-group differences and between group similarities and differences among privileged and marginalized clients. acknowledge clients’ communication style is influenced by their privileged and marginalized status.  2. knowledge: privileged and marginalized counselors possess knowledge of clients’ worldview, assumptions, attitudes, values, beliefs, biases, social identities, social group statuses, and experiences with power, privilege, and oppression. multicultural and social justice competent counselors: • develop knowledge of historical events and current issues that shape the worldview, cultural background, values, beliefs, biases, and experiences of privileged and marginalized clients. • develop knowledge of how stereotypes, discrimination, power, privilege, and oppression influence privileged and marginalized clients. • develop knowledge of multicultural and social justice theories, identity development models, and research pertaining to the worldview, culture, and life experiences of privileged and marginalized clients. • develop knowledge of their strengths and limitations in working with clients from privileged and marginalized groups. • develop knowledge of how to work through the discomfort that comes with learning about privileged and marginalized clients. • develop a lifelong plan to acquire knowledge of clients’ privileged and marginalized status. • develop knowledge of the attitudes, beliefs, prejudices, and biases they hold about privileged and marginalized clients. • develop knowledge of the individual, group, and universal dimensions of human existence of their privileged and marginalized clients. • develop knowledge of the communication style of their privileged and marginalized client (e.g., high context vs. low context communication, eye contact, orientation to time and space, etc.). 3. skills: privileged and marginalized counselors possess skills that enrich their understanding of clients’ worldview, assumptions, attitudes, values, beliefs, biases, social identities, social group statuses, and experiences with power, privilege, and oppression. multicultural and social justice competent counselors: • acquire culturally responsive evaluation skills to analyze how historical events and current issues shape the worldview, cultural background,    8  •  •  • •  •  •  •  •  values, beliefs, biases, and experiences of privileged and marginalized clients. acquire culturally responsive critical thinking skills to gain insight into how stereotypes, discrimination, power, privilege, and oppression influence privileged and marginalized clients. acquire culturally responsive application skills to apply knowledge of multicultural and social justice theories, identity development models, and research to one’s work with privileged and marginalized clients. acquire culturally responsive assessment skills to identify limitations and strengths when working with privileged and marginalized clients. acquire culturally responsive reflection skills needed to work through the discomfort that comes with learning about privileged and marginalized clients. acquire culturally responsive conceptualization skills to explain how clients’ privileged and marginalized status influence their culture, worldview, experiences, and presenting problem. acquire culturally responsive analytical skills to interpret the attitudes, beliefs, prejudices, and biases they hold about privileged and marginalized clients. acquire culturally responsive conceptualization skills to identify the individual, group, and universal dimensions of human existence of privileged and marginalized clients. acquire culturally responsive cross-cultural communication skills to interact with privileged and marginalized clients.  4. action: privileged and marginalized counselors take action to increase selfawareness of clients’ worldview, assumptions, attitudes, values, beliefs, biases, social identities, social group statuses, and experiences with power, privilege, and oppression. multicultural and social justice competent counselors: • take action by seeking out formal and informal opportunities to engage in discourse about historical events and current issues that shape the worldview, cultural background, values, beliefs, biases, and experiences of privileged and marginalized clients. • take action by attending professional development trainings to learn how stereotypes, discrimination, power, privilege, and oppression influence privileged and marginalized clients. • take action by applying multicultural and social justice theories, identity development models, and research to one’s work with privileged and marginalized clients. • take action by assessing ones limitations and strengths when working with privileged and marginalized clients on a consistent basis. • take action by immersing oneself in the communities in which privileged and marginalized clients reside to work through the discomfort that comes with learning about privileged and marginalized clients.    9 •  •  •  •  take action by using language to explain how clients’ privileged and marginalized status influence their culture, worldview, experiences, and presenting problem. take action by pursuing culturally responsive counseling to explore the attitudes, beliefs, prejudices, and biases they hold about privileged and marginalized clients. take action by collaborating with clients to identify the individual, group, and universal dimensions of human existence that shape the identities of privileged and marginalized clients. take action by consistently demonstrating cross-cultural communication skills required to effectively interact with privileged and marginalized clients.  iii. counseling relationship privileged and marginalized counselors are aware, knowledgeable, skilled, and action-oriented in understanding how client and counselor privileged and marginalized statuses influence the counseling relationship. 1. attitudes and beliefs: privileged and marginalized counselors are aware of how client and counselor worldviews, assumptions, attitudes, values, beliefs, biases, social identities, social group statuses, and experiences with power, privilege, and oppression influence the counseling relationship. multicultural and social justice competent counselors: • acknowledge that the worldviews, values, beliefs and biases held by privileged and marginalized counselors and clients will positively or negatively influence the counseling relationship. • acknowledge that counselor and client identity development shapes the counseling relationship to varying degrees for privileged and marginalized clients. • acknowledge that the privileged and marginalized status of counselors and clients will influence the counseling relationship to varying degrees. • acknowledge that culture, stereotypes, discrimination, power, privilege, and oppression influence the counseling relationship with privileged and marginalized group clients. • acknowledge that the counseling relationship may extend beyond the traditional office setting and into the community. • acknowledge that cross-cultural communication is key to connecting with privileged and marginalized clients. 2. knowledge: privileged and marginalized counselors possess knowledge of how client and counselor worldviews, assumptions, attitudes, values, beliefs, biases, social identities, social group statuses, and experiences with power, privilege, and oppression influence the counseling relationship.    10 multicultural and social justice competent counselors: • develop knowledge of the worldviews, values, beliefs and biases held by privileged and marginalized counselors and clients and its influence on the counseling relationship. • develop knowledge of identity development theories and how they influence the counseling relationship with privileged and marginalized clients. • develop knowledge of theories explaining how counselor and clients’ privileged and marginalized statuses influence the counseling relationship. • develop knowledge of how culture, stereotypes, discrimination, power, privilege, and oppression strengthen and hinder the counseling relationship with privileged and marginalized clients. • develop knowledge of when to use individual counseling and when to use systems advocacy with privileged and marginalized clients. • develop knowledge of cross-cultural communication theories when working with privileged and marginalized clients. 3. skills: privileged and marginalized counselors possess skills to engage in discussions with clients about how client and counselor worldviews, assumptions, attitudes, values, beliefs, biases, social identities, social group statuses, power, privilege, and oppression influence the counseling relationship. multicultural and social justice competent counselors: • acquire assessment skills to determine how the worldviews, values, beliefs and biases held by privileged and marginalized counselors and clients influence the counseling relationship. • acquire analytical skills to identify how the identity development of counselors and clients influence the counseling relationship. • acquire application skills to apply knowledge of theories explaining how counselor and clients’ privileged and marginalized statuses influence the counseling relationship. • acquire assessment skills regarding how culture, stereotypes, prejudice, discrimination, power, privilege, and oppression influence the counseling relationship with privileged and marginalized clients. • acquire evaluation skills to determine when individual counseling or systems advocacy is needed with privileged and marginalized clients. • acquire cross-cultural communication skills to connect with privileged and marginalized clients. 4. action: privileged and marginalized counselors take action to increase their understanding of how client and counselor worldviews, assumptions, attitudes, values, beliefs, biases, social identities, social group statuses, and experiences with power, privilege, and oppression influence the counseling relationship.    11 multicultural and social justice competent counselors: • take action by initiating conversations to determine how the worldviews, values, beliefs and biases held by privileged and marginalized counselors and clients influence the counseling relationship. • take action by collaborating with clients to identify the ways that privileged and marginalized counselor and client identity development influence the counseling relationship. • take action by exploring how counselor and clients’ privileged and marginalized statuses influence the counseling relationship. • take action by inviting conversations about how culture, stereotypes, prejudice, discrimination, power, privilege, and oppression influence the counseling relationship with privileged and marginalized clients. • take action by collaborating with clients to determine whether individual counseling or systems advocacy is needed with privileged and marginalized clients. • take action by using cross-communication skills to connect with privileged and marginalized clients.  iv. counseling and advocacy interventions privileged and marginalized counselors intervene with, and on behalf, of clients at the intrapersonal, interpersonal, institutional, community, public policy, and international/global levels. a. intrapersonal: the individual characteristics of a person such as knowledge, attitudes, behavior, self-concept, skills, and developmental history. intrapersonal interventions: privileged and marginalized counselors address the intrapersonal processes that impact privileged and marginalized clients. multicultural and social justice competent counselors: • employ empowerment-based theories to address internalized privilege experienced by privileged clients and internalized oppression experienced by marginalized clients. • assist privileged and marginalized clients develop critical consciousness by understanding their situation in context of living in an oppressive society. • assist privileged and marginalized clients in unlearning their privilege and oppression. • assess the degree to which historical events, current issues, and power, privilege and oppression contribute to the presenting problems expressed by privileged and marginalized clients. • work in communities to better understand the attitudes, beliefs, prejudices, and biases held by privileged and marginalized clients. • assist privileged and marginalized clients with developing self-advocacy skills that promote multiculturalism and social justice.    12 •  employ quantitative and qualitative research to highlight inequities present in current counseling literature and practices in order to advocate for systemic changes to the profession.  b. interpersonal: the interpersonal processes and/or groups that provide individuals with identity and support (i.e. family, friends, and peers). interpersonal interventions: privileged and marginalized counselors address the interpersonal processes that affect privileged and marginalized clients. multicultural and social justice competent counselors: • employs advocacy to address the historical events and persons that shape and influence privileged and marginalized client’s developmental history. • examines the relationships privileged and marginalized clients have with family, friends, and peers that may be sources of support or non-support. • assist privileged and marginalized clients understand that the relationships they have with others may be influenced by their privileged and marginalized status. • assist privileged and marginalized clients with fostering relationships with family, friends, and peers from the same privileged and marginalized group. • reach out to collaborate with family, friends, and peers who will be a source of support for privileged and marginalized clients. • assist privileged and marginalized clients in developing communication skills to discuss issues of power, privilege, and oppression with family, friends, peers, and colleagues. • employ evidenced-based interventions that align with the cultural background and worldview of privileged and marginalized clients. c. institutional: represents the social institutions in society such as schools, churches, community organizations. institutional interventions: privileged and marginalized counselors address inequities at the institutional level. multicultural and social justice competent counselors: • explore with privileged and marginalized clients the extent to which social institutions are supportive. • connect privileged and marginalized clients with supportive individuals within social institutions (e.g., schools, businesses, church, etc.) who are able to help alter inequities influencing marginalized clients. • collaborate with social institutions to address issues of power, privilege, and oppression impacting privilege and marginalized clients. • employ social advocacy to remove systemic barriers experienced by marginalized clients within social institutions. • employ social advocacy to remove systemic barriers that promote privilege that benefit privileged clients.    13 •  •  balance individual counseling with systems level social advocacy to address inequities that social institutions create that impede on human growth and development. conduct multicultural and social justice based research to highlight the inequities that social institutions have on marginalized clients and that benefit privileged clients.  d. community: the community as a whole represents the spoken and unspoken norms, value, and regulations that are embedded in society. the norms, values, and regulations of a community may either be empowering or oppressive to human growth and development. community interventions: privileged and marginalized address community norms, values, and regulations that impede on the development of individuals, groups, and communities. multicultural and social justice competent counselors: • take initiative to explore with privileged and marginalized clients regarding how community norms, values, and regulations embedded in society that hinder and contribute to their growth and development. • conduct qualitative and quantitative research to evaluate the degree to which community norms, values, and regulations influence privileged and marginalized clients. • employ social advocacy to address community norms, values, and regulations embedded in society that hinder the growth and development of privileged and marginalized clients. • utilize the norms, values and regulations of the marginalized client to shape the community norms, values, and regulations of the privileged client. e. public policy: public policy reflects the local, state, and federal laws and policies that regulate or influence client human growth and development. public policy interventions: privileged and marginalized counselors address public policy issues that impede on client development with, and on behalf of clients. multicultural and social justice competent counselors: • initiate discussions with privileged and marginalized clients regarding how they shape and are shaped by local, state, and federal laws and policies. • conduct research to examine how local, state, and federal laws and policies contribute to or hinder the growth and development of privileged and marginalized clients. • engage in social action to alter the local, state, and federal laws and policies that benefit privileged clients at the expense of marginalized clients. • employ social advocacy to ensure that local, state, and federal laws and policies are equitable toward privileged and marginalized clients.    14 •  • •  employ social advocacy outside the office setting to address local, state, and federal laws and policies that hinder equitable access to employment, healthcare, and education for privileged and marginalized clients. assist with creating local, state, and federal laws and policies that promote multiculturalism and social justice. seek out opportunities to collaborate with privileged and marginalized clients to shape local, state, and federal laws and policies.  f. international and global affairs: international and global concerns reflect the events, affairs, and policies that influence psychological health and well-being. international and global affairs interventions: privileged and marginalized counselors address international and global events, affairs and polices that impede on client development with, and on behalf of, clients. multicultural and social justice competent counselors: • stay current on international and world politics and events. • seek out professional development to learn about how privileged and marginalized clients influence, and are influenced by, international and global affairs. • acquire knowledgeable of historical and current international and global affairs that are supportive and unsupportive of privileged and marginalized clients. • learn about the global politics, policies, laws, and theories that influence privileged and marginalized clients. • utilize technology to interact and collaborate with international and global leaders on issues influencing privileged and marginalized clients. • take initiative to address international and global affairs to promote multicultural and social justice issues. • utilize research to examine how international and global affairs impact privileged and marginalized clients.  
       


authors_index: li, p. f. jonah
secondary_title_index: journal of humanistic psychology
abstract_index:
       although there is an upward trend in people who self-identify as “spiritual but not religious” (sbnr), they largely remain understudied in psychology. multiculturally and ethically, it is important for psychologists to possess informed knowledge to work with individuals with religious and spiritual backgrounds. guided by the tripartite model of meaning in life and conceptualizing beliefs in free will and determinism as meaning frameworks, this study examined the associations among meaning frameworks, meaning dimensions (i.e., comprehension, purpose, and mattering), and meaning judgment among sbnrs. results indicated that belief in free will was positively associated with all three meaning dimensions but not meaning judgment. belief in free will positively predicted all three meaning dimensions and meaning judgment. mediation analyses revealed that belief in free will was indirectly associated with meaning judgment through its positive relation with comprehension. belief in determinism was not associated with any study variables; purpose and mattering did not mediate the relation between meaning frameworks and meaning judgment. these findings provide important implications for psychologists who work with sbnrs regarding their culturally distinct experiences of existential meaning. the strengths and limitations of the current study as well as future research directions are discussed.     

title_index:
       being spiritual but not religious (sbnr): testing the tripartite meaning in life model with beliefs in free will and determinism as meaning frameworks     

full_text_index:
       1273353 research-article2024  jhpxxx10.1177/00221678241273353journal of humanistic psychology xx(x)li  original manuscripts  being spiritual but not religious (sbnr): testing the tripartite meaning in life model with beliefs in free will and determinism as meaning frameworks  journal of humanistic psychology  1 –22  the author(s) 2024 article reuse guidelines: sagepub.com/journals-permissions https://doi.org/10.1177/00221678241273353 doi: 10.1177/00221678241273353 journals.sagepub.com/home/jhp  p. f. jonah li1  abstract although there is an upward trend in people who self-identify as “spiritual but not religious” (sbnr), they largely remain understudied in psychology. multiculturally and ethically, it is important for psychologists to possess informed knowledge to work with individuals with religious and spiritual backgrounds. guided by the tripartite model of meaning in life and conceptualizing beliefs in free will and determinism as meaning frameworks, this study examined the associations among meaning frameworks, meaning dimensions (i.e., comprehension, purpose, and mattering), and meaning judgment among sbnrs. results indicated that belief in free will was positively associated with all three meaning dimensions but not meaning judgment. belief in free will positively predicted all three meaning dimensions and meaning judgment. mediation analyses revealed that belief in free will was indirectly associated with meaning judgment through its positive relation with comprehension. belief in determinism was not associated with any study variables; purpose and mattering did not mediate the relation  1  university of washington tacoma, wa, usa  corresponding author: p. f. jonah li, school of interdisciplinary arts and sciences, university of washington tacoma, mcdonald smith 106c, 1900 commerce street, tacoma, wa 98402-3100, usa. email: jonahli@uw.edu  
  2  journal of humanistic psychology 00(0)  between meaning frameworks and meaning judgment. these findings provide important implications for psychologists who work with sbnrs regarding their culturally distinct experiences of existential meaning. the strengths and limitations of the current study as well as future research directions are discussed. keywords multicultural competence, diversity, existential meaning, religion and spirituality, non-binary identity  psychology, known as the scientific study of the human spirit or psyche, has historical traces in religion and philosophy (james, 1890, 1902). however, its subsequent development was reduced first to the inquiry of mind, then of behavior, followed by the neurological bases of behavior (benjamin, 2023; casaletto & heaton, 2017; wertheimer & puente, 2020). after a while, psychologists attended to the study of cognition and in recent decades, have restored interest in exploring religion and spirituality (friedenberg et al., 2021; paloutzian & park, 2014; f. watts, 2017). indeed, there are several reasons why psychologists should explore religion and spirituality. for one, religion and spirituality play an integral role in many people’s lives in the u.s. national polls have indicated that 72% of americans reported that religion is “fairly important” or “very important” to them (brenan, 2018). second, religion and spirituality have an immense influence on well-being (cohen & johnson, 2017; ryff, 2021; unterrainer et al., 2014; wilt et al., 2017). meta-analytic findings have suggested that religiosity, spirituality, and religious/spiritual experience are positively associated with well-being (coelho-junior et al., 2022; garssen et al., 2021; oxhandler et al., 2021; yaden et al., 2022). third, religion and spirituality concern important aspects of human diversity (currier et al., 2023; vieten et al., 2016; vieten & lukoff, 2022). people with different religious and spiritual backgrounds may differ in their systems of worldviews, core beliefs, values, moral judgment, guiding principles, and ways of living. from a multicultural competence standpoint, it is imperative for practicing psychologists (e.g., humanistic psychotherapists) to possess informed knowledge when working with clients with backgrounds in religion and spirituality (currier et al., 2023; vieten et al., 2016; vieten & lukoff, 2022).  
  li  3  beyond the binary identification: being spiritual but not religious in the united states, most people either self-identify as christian or unaffiliated (e.g., atheist, agnostic, or nothing in particular) (pew research center, 2024). beyond this binary approach, there is an upward trend in people selfidentify as “spiritual, but not religious” (hereafter referred to as “sbnr”) (edgell et al., 2016; lee, 2015; lipka & gecewicz, 2017; g. watts, 2018). to conceptualize this self-identification, one needs to distinguish between the meaning of religion and spirituality (asih et al., 2020; paloutzian & park, 2021). religion can be referred to as an “organized belief system, guided by shared values, practices and understandings of the divine, and involvement in a religious community,” whereas spirituality can be defined “more broadly as an individual’s internal sense of connection to something beyond oneself, which could be perceived as a higher power or god, and/or a more general sense of the sacred, consciousness, or interconnectedness to all of nature and life” (vieten & lukoff, 2022, p. 27). although both religion and spirituality are concerned with meanings, values, and the sacred, “to be spiritual but not religious is to emphasize the former [spiritual] over the latter [religious]” (wixwat & saucier, 2021, p. 122). indeed, such a nuanced self-identification of being spiritual but not religious (sbnr) has been supported by research findings highlighting that subjective spirituality and traditionally oriented religiousness differ in their developmental trajectories as well as correlates of personality traits and mental health outcomes (koenig, 2015; mihaljevic et al., 2016). what are the motivations for people to self-identify as sbnr? research has suggested that people who self-identify as sbnr might find their belief system misaligned with their religion (mercadante, 2020; thiessen & wilkins-laflamme, 2017; wixwat & saucier, 2021). they might possess more new-age beliefs and practices, challenging traditional and conventional systems and acts (carey, 2018; mercadante, 2014; mercadante, 2020). they might be more likely to adopt an individualistic ethic instead of relying on god or scripture as the moral authority (carey, 2018; johnson et al., 2018; mcclure, 2017; wixwat & saucier, 2021). they might perceive god as a cosmic force rather than a personal being (johnson et al., 2018; mcclure, 2017; mercadante, 2020). people who self-identify as sbnr might hold paranormal beliefs and savor an experiential relationship to the supernatural (e.g., mystical experiences; mercadante, 2014; willard & norenzayan, 2017). being dissatisfied with their religion in the past might be another reason to be self-identified as sbnr (exline et al., 2014; thiessen & wilkinslaflamme, 2017; vieten & lukoff, 2022). for instance, japanese women  
  4  journal of humanistic psychology 00(0)  once reported that their religion did not satisfy their emotional needs and they felt a sense of discomfort with the gender norms (kayoko, 2017). also, people who suffer from religious abuse or trauma might exit their religious communities and undergo identity change (ellis et al., 2022). taken together, these experiences might motivate people to self-identify as sbnr in the united states––a group of people understudied in psychology.  the tripartite model of meaning in life the third force in psychology, humanistic psychology, is primarily concerned with human capacities and potentialities, including existential meaning in life (hereafter referred to as “mil”) (bugental, 1964). indeed, mil has been identified as a cornerstone of well-being and optimal functioning (frankl, 1985, 2014; li et al., 2019; wong, 2017, 2020)––an indicator of self-transcendence (frankl, 1966, 1967; li et al., 2022a; wong, 2016a, 2016b, 2021). recently, there has been a growing scholarly consensus on conceptualizing mil as three dimensions (george & park, 2016; heintzelman & king, 2014; king & hicks, 2021; martela & steger, 2016). accordingly, the three dimensions include comprehension (hereafter referred to as “comprehension,” which is defined as the degree to which one’s life is experienced as making sense; also known as coherence), purpose (which is referred to as individuals’ experience of being directed and motivated by valued life goals), and existential mattering (hereafter referred to as “mattering,” which is understood as one’s feeling of importance to the world; also referred to as significance). such a conceptualization has garnered support from empirical evidence, such as correlations and factor analyses (chang, 2024; costin & vignoles, 2020; george & park, 2017; valdivia & li, 2022; zambelli & tagliabue, 2024), and experiments (martela & steger, 2023). the tripartite model of meaning in life (mil) proposed that meaning frameworks contribute to meaning dimensions, leading to one’s meaning judgment (george & park, 2016). meaning frameworks can be defined as “the propositions individuals hold about how things are in the world and how things will be” (p. 206), meaning that judgment is understood as one’s subjective judgment regarding how meaningful their life is (george & park, 2016). in the context of the tripartite model of mil (george & park, 2016), a considerable body of studies has focused on meaning dimensions and their relations to mil judgment (e.g., costin & vignoles, 2020; george & park, 2017; martela & steger, 2016, 2023; zambelli & tagliabue, 2024). however, there are substantially fewer studies investigating the nuances among meaning frameworks, meaning dimensions, and meaning judgment. to the best of  
  li  5  our knowledge, to date, only one study examined the relations among meaning frameworks, meaning dimensions, and meaning judgment (costin & vignoles, 2022). using samples from atheists, agnostics, and all other religious groups in the united states and the united kingdom, costin and vignoles (2022) examined the general relations among several mental representations of self and the world (e.g., beliefs [including belief in free will], identity, values, and attitudes), meaning dimensions, and meaning judgment. they found that belief in free will significantly predicted meaning judgment and moderated the relations between meaning dimensions and meaning judgment. while findings from costin and vignoles (2022) insightfully demonstrated that mental representations such as beliefs functioned as meaning frameworks and predicted meaning dimensions as well as meaning judgment, there are two limitations. first, they did not examine the magnitude of associations of beliefs in free will and determinism (as meaning frameworks) with meaning dimensions and meaning judgment.1 indeed, costin and vignoles called for future studies to test “whether mental representations within the same domain expressed as . . . beliefs . . . promote [a] sense of mil differently” (supp. material b, p. 11). second, they primarily studied participants who self-identified as atheists, agnostics, christians, and other religions, but not those who self-identified as sbnr. as scholars have emphasized, it is in psychologists’ interest of multicultural competence and ethical considerations to study people who self-identify as sbnr––a minority group that is relatively understudied in religion and spirituality (vieten et al., 2016; vieten & lukoff, 2022).  the present study against this backdrop, the present study aims to examine the tripartite model of mil (george & park, 2016) with a sample of people who self-identified as sbnr. within this model, we conceptualized beliefs in free will and determinism as meaning frameworks as well as comprehension, purpose, and mattering as meaning dimensions (george & park, 2016). grounded in the tripartite model of mil (george & park, 2016), we first hypothesized (h1) positive, significant correlations among meaning frameworks, meaning dimensions, and meaning judgment. second, to examine the distinct dimensions and unique explanatory power of meaning frameworks in predicting meaning dimensions and meaning judgment, we conducted multiple regression and mediation analyses. based on george and park’s (2016) theoretical notion, we hypothesized (h2) that both beliefs in free will and determinism would positively and significantly predict comprehension, purpose, and  
  6  journal of humanistic psychology 00(0)  mattering, respectively, whereas comprehension, purpose, and mattering would positively and significantly predict subjective judgment of meaning. in addition, we hypothesized (h3) that comprehension, purpose, and mattering would each significantly and positively mediate the positive relations between beliefs in free will and determinism as well as meaning judgment, respectively. because extant literature has limited studies on mil as well as beliefs in free will and determinism among people who self-identified as sbnr, our directional hypotheses were primarily based on the theoretical notions of the tripartite model of mil (george & park, 2016). similar to previous studies in humanistic psychology (li et al., 2021a; li et al., 2022b; li & wong, 2020), we adopted the logical positivist philosophical perspective with a goal of understanding general principles of human psychological functioning across individuals (benton & craib, 2023; comte & bridges, 2015). within the logical positivist philosophical perspective, this study primarily used quantitative, statistical techniques to address our research question. known as a “narrower band” form of psychological methods (schneider, 2014, p. 92), our quantitative approach complements qualitative approaches to understanding human experiences (hefferon et al., 2017; robbins, 2015).  method participants and procedure this study was part of a project examining people’s mil experience. after receiving the institutional review board’s approval, we recruited participants using amazon’s mechanical turk (mturk). mturk workers who agreed to partake in the study completed an online questionnaire. each mturk worker was compensated usd 0.5. of the initial 764 participants, 112 respondents were excluded due to failing 2 attention check questions. of the 652 respondents, we only selected participants who self-identified as “spiritual but not religious” in a demographic question item that asks, “what is your religion?” the final sample included 68 participants (50% male, 50% female; mage 34.37 years, sd  10.96). most participants self-identified as european/white american (42.6%), followed by asian american (25.0%), african/black american (16.2%), native american (5.9%), latinx american (4.4%), and other racial/ ethnic backgrounds (5.9%). regarding participants’ sexual orientation, most were heterosexual (80.9%), followed by bisexual (14.7%), and other orientations (e.g., gay, questioning, etc.; 4.5%). for relationship status, 38.2% were married, 22.1% were in a committed relationship, 26.5% were single, and 13.3% reported other relationship status (e.g., casual relationships).  
  li  7  measures meaning frameworks. similar to prior studies (costin & vignoles, 2022), we conceptualized people’s beliefs in free will and determinism as two meaning frameworks. operationally, we used two subscales of the free will and determinism-plus scale (fad-plus; paulhus & carey, 2011). first, we used the 7-item free will subscale to assess participants’ subscription to free will beliefs. example items include, “people have complete control over the decisions they make.” second, we adopted the five-item fatalistic determinism subscale to assess participants’ endorsement of deterministic beliefs. example items include, “fate already has a plan for each of us.” compared with other subscales (e.g., unpredictable), the fatalistic determinism subscale appears to better reflect the traditional notion of determinism. for both subscales, participants rated scale items with a 5-point likert-type scale, ranging from 1 (strongly disagree) to 5 (strongly agree). higher scores reflect higher levels of belief in free will and determinism. for evidence of construct validity, the free will subscale and the fatalistic determinism subscale were positively correlated with internal and external locus of control, respectively (paulhus & carey, 2011). meaning dimensions. to assess the meaning dimensions, we used the three subscales of the multidimensional existential meaning in life scale (george & park, 2017): the five-item comprehension subscale, the five-item purpose subscale, and the five-item mattering subscale. example items include “i understand my life” for the comprehension subscale, “i have certain life goals that compel me to keep going” for the purpose subscale, and “i am certain that my life is of importance” for the mattering subscale. participants rated scale items with a 7-point likert-type scale, ranging from 1 (very strongly disagree) to 7 (very strongly agree). higher scores reflect higher levels of comprehension, purpose, and mattering, respectively. for evidence of construct validity, the comprehension subscale was positively correlated with dogmatism, the purpose subscale was positively associated with behavioral activation, and the mattering subscale was positively linked to selfliking and self-competence (costin & vignoles, 2020; george & park, 2017). meaning judgment. following previous studies (li et al., 2021b; wang et al., 2016), we used a one-item scale to assess participants’ subjective judgment of their mil (george & park, 2017). participants rated the item “how meaningful is your life in general?” using a 6-point likert-type scale ranging from 1 (not at all meaningful) to 6 (very meaningful). higher scores reflect a higher  
  8  journal of humanistic psychology 00(0)  level of subjective mil judgment. this one-item scale did not deliberately define mil so that participants would subjectively judge their mil level.  results data screening prior to data analysis, we performed data screening. there were minimal missing values ( 1.5%) only on one study variable (i.e., meaning judgment). little’s missing-completely-at-random (mcar) test was nonsignificant, χ2(7) 4.729, p .693, indicating that the missing pattern was completely random. therefore, we used the expectation maximization algorithm to impute the missing values, which has been shown to be superior to other methods such as listwise deletion and mean substitution (cook, 2021; lang & little, 2018). we also examined normality distribution and the absence of multicollinearity. as shown in table 1, both skewness and kurtosis of the study variables were within an acceptable range (–3 to 3 for skewness and 7 to 7 for kurtosis; byrne, 2013). in addition, the vif and tolerance values were 1.003 and 0.997, respectively, which were within the acceptable range ( 4 for vif and 0.25 for tolerance), suggesting the absence of multicollinearity (shrestha, 2020).  power analysis and sample size determination in addition, we conducted power analysis for correlation and regression analyses to determine if our sample size was adequate for statistical analyses. using g*power (faul et al., 2009), we found that our sample size was enough to detect at least a medium (r .3; minimum n 67) but not a small effect size (r .1; minimum n 616) in a one-tailed bivariate correlational test; our sample size was also adequate to identify at least a medium (f 2 .15; minimum n 68), but not a small effect size (f 2 02; minimum n 485) in a multiple regression test with two predictors. regarding mediation analyses, scholars have stated that a small sample size of 50 can be enough to detect indirect effects using percentile bootstrap confidence intervals (cis) without showing seriously inflated type 1 errors (tofighi & mackinnon, 2016).  data analytic plan to address our first hypothesis, we conducted bivariate correlations. for our second hypothesis, we conducted multiple linear regressions. for our third  
  li  9  table 1. correlations, alpha coefficients, means, and standard deviations among study variable. variables  1  2  1. belief in free will — 2. belief in determinism –.06 — 3. comprehension .54*** .07 4. purpose .64*** –.06 5. mattering .35** .20 6. meaning judgment .14 .03 m 3.78 3.03 sd 0.73 1.00 α .82 .81 skewness –0.03 –0.19 kurtosis –0.67 –0.73  3  4  5  6  — .84*** — .64*** .60*** — .55*** .38*** .39*** — 5.01 5.20 4.58 4.85 1.35 1.24 1.27 1.23 .93 .88 .81 — –0.60 –0.58 –0.79 –1.45 0.39 0.18 1.03 2.38  note. n 68. **p .01. ***p .001.  hypothesis on mediation effects, we conducted the percentile bootstrap cis using the spss process macro (hayes, 2022). percentile bootstrap cis are a type of resampling technique used to estimate an empirical approximation of the sampling distribution of the mediation effect (alfons et al., 2022). a significant mediation effect was detected if the 95% cis of the mediation effect did not contain zero.  main results the means, standard deviations, correlations, and cronbach’s alphas are presented in table 1. our first hypothesis (h1) was that meaning frameworks, meaning dimensions, and meaning judgment would be positively correlated with each other. partially supporting our first hypothesis, belief in free will was significantly and positively correlated with all three meaning dimensions; all three meaning dimensions were significantly and positively correlated with each other as well as meaning judgment. contrary to our hypothesis, belief in free will was not significantly correlated with meaning judgment; belief in determinism was not significantly correlated with any study variables. our second hypothesis (h2) was that meaning frameworks would positively predict meaning dimensions and meaning judgment. as shown in table 2, we found that belief in free will significantly and positively predicted  
  10  journal of humanistic psychology 00(0)  table 2. multiple regression models. variable outcome: comprehension belief in free will belief in determinism outcome: purpose belief in free will belief in determinism outcome: mattering belief in free will belief in determinism outcome: meaning judgment belief in free will belief in determinism  b  se  β  1.02 0.13  0.19 0.14  .55*** .10  1.08 –0.03  0.16 0.12  .64*** –.03  0.64 0.28  0.20 0.14  .37** .22  0.24 0.04  0.21 0.15  .14 .03  r2 .31***  .41***  .17**  .02  note. n 68. **p .01. ***p .001.  meaning dimensions, including comprehension, purpose, and mattering, whereas belief in determinism did not significantly predict any meaning dimensions. contrary to our hypothesis, both beliefs in free will and determinism did not significantly predict meaning judgment. in short, we found mixed support for our first two hypotheses. our third hypothesis (h3) was to examine a mediation model in which meaning frameworks would be positively related to meaning judgment via its positive associations with meaning dimensions. we found that comprehension significantly mediated the relation between belief in free will and meaning judgment, b 0.70, standard error 0.21, β .41, 95% ci [0.315, 1.146] (see table 3 and figure 1, panel a). after controlling for comprehension as the mediator, the direct association from belief in free will to meaning judgment remained nonsignificant, b 0.24, standard error 0.21, β .14, 95% ci [–0.171, 0.650] (also known as full mediation; fuller, 2018). beyond this result, no other significant mediation paths were found (see table 3 and figure 1, panel b). in sum, we found a small extent of support for our third hypothesis.  discussion this study sought to test the tripartite model of mil (george & park, 2016) with a sample of people who self-identified as sbnr. grounded in the  
  li  11  table 3. mediation paths. unstandardized indirect effect path x1 m1 y x1 m2 y x1 m3 y x2 m1 y x2 m2 y x2 m3 y  completely standardized indirect effect  b (se)  95% ci  b (se)  95% ci  0.70 (0.21) –0.20 (0.22) 0.04 (0.09) 0.06 (0.13) 0.02 (0.07) 0.03 (0.04)  [0.315, 1.146] [–0.692, 0.200] [–0.103, 0.285] [–0.181, 0.351] [–0.107, 0.209] [–0.032, 0.115]  0.41 (0.13) –0.12 (0.13) 0.03 (0.06) 0.05 (0.10) 0.02 (0.06) 0.02 (0.03)  [0.188, 0.685] [–0.421, 0.118] [–0.060, 0.168] [–0.162, 0.253] [–0.080, 0.175] [–0.028, 0.086]  note. n 68; x1 belief in free will; x2 belief in determinism; m1 comprehension; m2 purpose; m3 mattering; y meaning judgment.  tripartite model of mil (george & park, 2016), we conceptualized (a) beliefs in free will and determinism as meaning frameworks, (b) comprehension, purpose, and mattering as meaning dimensions, and (c) one’s subjective mil judgment as meaning judgment. guided by this conceptualization, this study investigated the associations among meaning frameworks, meaning dimensions, and meaning judgment in individuals who self-identified as sbnr. our first hypothesis was that meaning frameworks, meaning dimensions, and meaning judgment would be significantly and positively correlated with each other. we found mixed support for our hypothesis. we found that belief in free will and all three meaning dimensions were significantly and positively correlated; meaning judgment was positively and significantly correlated with meaning dimensions; and meaning dimensions were correlated with each other. however, contrary to our expectation, belief in free will was not correlated with meaning judgment, and belief in determinism had no significant correlations with other meaning frameworks (i.e., belief in free will), meaning dimensions, as well as meaning judgment. our second hypothesis was that meaning frameworks would positively predict meaning dimensions and meaning judgment. our findings were similar to the first hypothesis, providing mixed support for our second hypothesis. we found that belief in free will significantly and positively predicted all three meaning dimensions, but belief in determinism was not a significant predictor of any meaning dimensions. furthermore, both beliefs in free will and determinism did not significantly predict meaning judgment. our third hypothesis on the mediation model was that both beliefs in free will and determinism would be indirectly and positively associated with meaning judgment through their positive associations with comprehension,  
  12  journal of humanistic psychology 00(0)  figure 1. visual depiction of the mediation models.  note. solid arrows represent significant associations whereas dotted arrows represent nonsignificant associations. b unstandardized regression coefficient; se standard error; β standardized regression coefficient. *p .05. **p .01. ***p .001.  purpose, and mattering, respectively. we only found one significant mediation finding. specifically, comprehension fully, positively, and significantly mediated the relation between belief in free will and meaning judgment. that is, comprehension acted as a mechanism for belief in free will to be positively  
  li  13  associated with meaning judgment; after accounting for comprehension as a mediator, belief in free will was no longer associated with meaning judgment. no indirect associations were found for belief in determinism. the current findings are consistent with the literature. first, people who profess to be sbnr may prefer the free will perspective over the deterministic stance. indeed, a central goal for them may be to discover their “true self” and to live “authentically” by staying true to that self (huss, 2014; mercadante, 2014). with this goal, people as sbnr may reject external authority’s power that defines their core identity and lifestyle (mercadante, 2014; thiessen & wilkins-laflamme, 2017), may emphasize individualism, free creative choice, and free authentic expression (parsons, 2022), and may stress the perspective that “every person . . . should be free to decide how best to live [their] life even if it involves bad choices” (woodhead, 2017, p. 22). second, our findings from correlations and regressions highlight that people who self-identified as sbnr tend to draw upon the free will perspective to comprehend their life experiences (i.e., comprehension), pursue future life goals (i.e., purpose), and experience a sense of significance to the world (i.e., mattering). regarding the link from belief in free will to comprehension and purpose, people who are sbnr might be attracted to the notion of self-determination to autonomously decide personalized approaches to make sense of their life experiences and pursue their life goals, rather than relying on god or scripture to guide their journey (mcclure, 2017; mercadante, 2014). for instance, people who are sbnr may find interest in existential doctrines such as radical freedom, “to be free is to be condemned to be free” (sartre, 1978, p. 129), which stresses that human beings are fundamentally free, and individuals are not predetermined by external forces or predefined natures but autonomously understand their life experiences and responsibly pursue their own valued life goals (sartre, 1978). regarding the link from belief in free will to mattering, people who are sbnr may not rely on god or scripture to feel validated or significant; instead, they might autonomously experience feelings of universal connectedness and oneness (i.e., harmony) with nature and the universe (garfield et al., 2014; u. king, 2017; willard & norenzayan, 2017). third, our findings on mediation suggest that comprehension serves as a mechanism between belief in free will and meaning judgment. this finding is consistent with costin and vignoles’s (2022) writings that comprehension “may be a . . . reliably important feature of meaning frameworks [i.e., belief in free will] that serve descriptive functions] (supp. material b, p. 9). indeed, comprehension stresses one’s experience of understanding life events (george & park, 2016), and the free will perspective can function as a life scheme––a cognitive representation of individuals’ life events (li & wong,  
  14  journal of humanistic psychology 00(0)  2020), facilitating one’s comprehension, promoting their meaning judgment. we did not find purpose and mattering as a mediator between meaning frameworks and meaning judgment. this nonsignificant finding makes conceptual sense because the pursuit of purpose often takes time (which involves one’s committed dedication and effortful progress; li et al., 2023). also, previous research has shown that people who are sbnr tend to struggle with a sense of belonging in the wider world (versus feeling significant to the world; mercadante, 2014; mercadante, 2020). instead of feeling as important members of an affiliated group, they might feel free to attend the group on the “as-needed” basis at will, retaining a “churchless faith” (gerhardt, 2018; mercadante, 2020). finally, our findings might open new research questions. different from prior research (costin & vignoles, 2022), our study showed that belief in free will as a meaning framework did not predict meaning judgment among people who are sbnr. departing from the tripartite model of mil (george & park, 2016), our findings indicated that only comprehension mediated the relation between belief in free will and meaning judgment. other meaning dimensions, such as purpose and mattering, did not serve as a mediator. these findings suggest that people who are sbnr might be culturally distinct from other populations (e.g., atheists, agnostics, and christians) and may draw upon alternative beliefs (e.g., magical, supernatural beliefs) to judge mil (willard & norenzayan, 2017). consistent with recent studies (e.g., li et al., 2023), our study raises questions on conceptualizing comprehension, purpose, and mattering as the three meaning dimensions. other possible meaning dimensions might include self-transcendence, personal growth, and spirituality (frankl, 1966; li et al., 2023; wong, 2016a, 2016b, 2021). several strengths in this study are worth mentioning. to the best of our knowledge, this is the first study to examine people who self-identify as sbnr in the context of the tripartite model of mil (george & park, 2016). conceptualizing beliefs in free will and determinism as meaning frameworks, we advanced the literature by examining their relations with dimensions and judgment of meaning among people who are sbnr. we also demonstrate the important role of belief in free will on existential meaning among people who are sbnr. consistent with the literature, people who are sbnr may favor notions of free will over determinism, and autonomously make sense of their life experience with unconventional perspectives, perceiving a sense of mil. several limitations in our study should also be noted. first, our sample is small (n 100), and our participants self-identified as americans. as prior research has shown that european samples tend to have a lower rate of sbnr self-identification (wixwat & saucier, 2021), future research could replicate our findings with larger, multicultural (e.g., european, asian, african, etc.)  
  li  15  samples. second, we did not further probe participants’ previous religious experiences. those who were christians, atheists, or agnostics previously but later self-identified as sbnr may have culturally distinct experiences on existential meaning. future research can investigate within- and betweengroup differences among those who are sbnr. as our findings raise questions on the tripartite conceptualization of meaning dimensions, culturally specific models on existential meaning (including meaning dimensions) could be future theoretical and empirical research directions. third, our cross-sectional correlational design did not allow us to draw any causal relationships in our findings. we encourage future longitudinal and experimental studies to test the causal associations based on the tripartite mil model (george & park, 2016).  conclusion in sum, the present study examined the tripartite model of meaning in life (george & park, 2016) with a sample of people who self-identified as sbnr. conceptualizing beliefs in free will and determinism as meaning frameworks, we found that endorsing belief in free will is conducive to comprehending life events, pursuing valued life goals, experiencing a sense of mattering to the world, and judging a sense of meaning in one’s life, based on findings from correlational, regression, and mediation analyses. importantly, endorsing the notion of free will may help one understand their life experiences, contributing to an overall sense of meaning in life. we encourage humanistic psychologists and researchers to attend to people who are sbnr––an understudied population, and their culturally distinct experiences on existential meaning. we also call for future theoretical and empirical research advancement. declaration of conflicting interests the author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.  funding the author(s) received no financial support for the research, authorship, and/or publication of this article.  orcid id p. f. jonah li  https://orcid.org/0000-0001-7023-4919  
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  22  journal of humanistic psychology 00(0)  author biography p. f. jonah li, phd, is an assistant professor at the school of interdisciplinary arts and sciences at the university of washington tacoma. his research interests include positive psychology, humanistic and existential psychology, and asian american mental health.  
       


secondary_title_index: journal of religion and health
title_index: psychological distress among religious nonbelievers: a systematic review
full_text_index:
       j relig health (2012) 51:72–86 doi 10.1007/s10943-011-9541-1 original paper  psychological distress among religious nonbelievers: a systematic review samuel r. weber • kenneth i. pargament • mark e. kunik • james w. lomax ii • melinda a. stanley  published online: 1 october 2011  springer science business media, llc 2011  abstract studies of religious belief and psychological health are on the rise, but most overlook atheists and agnostics. we review 14 articles that examine differences between nonbelievers and believers in levels of psychological distress, and potential sources of distress among nonbelievers. various forms of psychological distress are experienced by nonbelievers, and greater certainty in one’s belief system is associated with greater psychological health. we found one well-documented source of distress for nonbelievers: negative perceptions by others. we provide recommendations for improving research on nonbelievers and suggest a model analogous to pargament’s tripartite spiritual struggle to understand the stresses of nonbelief. keywords  religion atheism agnosticism mental health psychological distress  samuel weber was a medical student at baylor college of medicine when he worked on this project. s. r. weber (&) department of psychiatry, the ohio state university, 1670 upham drive, columbus, oh 43210, usa e-mail: samuelrobertweber@gmail.com k. i. pargament bowling green state university, bowling green, oh, usa m. e. kunik m. a. stanley va hsr&d houston center of excellence, houston, tx, usa m. e. kunik m. a. stanley michael e. debakey va medical center, houston, tx, usa m. e. kunik j. w. lomax ii m. a. stanley baylor college of medicine, houston, tx, usa m. e. kunik m. a. stanley va south central mental illness, research, education and clinical center, houston, tx, usa  123  
  j relig health (2012) 51:72–86  73  introduction religious belief has become increasingly recognized as a significant factor contributing to individual well-being. a growing body of literature links religious belief to improvements in physical health (koenig et al. 2001), mental health (koenig 1998), and coping (pargament 2001). while this has led some to conclude that being religious is generally beneficial for physical and mental health (koenig et al. 2001), this conclusion overlooks two key qualifiers. first, some forms of religious belief and behavior have been associated with increased symptoms of psychological distress. religious doubt (krause and wulff 2004) and feelings of alienation from god (trevino et al. 2010; exline et al. 2000) have been associated with increased depressive symptoms. unpleasant personal encounters in church settings are commonly associated with distress, particularly among clergy and the elderly (krause et al. 1998, 2000; nielsen 1998). negative religious coping (i.e., a punishing god, demonic reprisals) is associated with lower quality of life and increased depression when compared to other religious coping strategies (meisenhelder and marcum 2004; koenig et al. 1992; pargament et al. 1998, 2001, 2004; smith et al. 2000). a growing body of literature has examined spiritual struggles and their defining elements, including troubled relationships with god, negative social encounters in religious settings, and chronic religious doubting (ellison and lee 2010; exline 2002; pargament et al. 2005). second, although higher levels of religiousness among people with at least a minimum level of religiousness may contribute to individual well-being, we do not know whether non-religiousness is deleterious to psychological functioning. the literature has generally focused on people with at least a minimal level of religiousness. studies at times exclude religious nonbelievers from participation or do not sample them in sufficient numbers to allow conclusions about this subgroup (krause and wulff 2004; meisenhelder and marcum 2004; pargament et al. 2004, krause et al. 1998; pargament 2001). as the study of religion and health becomes more refined, we must not overlook the well-being of religious nonbelievers (a growing subpopulation within the united states (pew forum on religion & public life 2009)). the purpose of this study was to review studies evaluating differences between religious nonbelievers and believers in levels of psychological distress and to identify potential sources of distress among nonbelievers. whitley reviewed literature on atheism and mental health in 2010 and found no articles that fit his search criteria (whitley 2010). his review was limited by a narrow set of search terms (atheis*, religi*, mental health, and psychiat*) used within a single database (medline). our study is distinct from whitley’s in our broader perspective on nonbelievers (including atheists and agnostics) and our focus on symptoms and potential sources of psychological distress. our decision to include both atheists and agnostics in this review reflects a conscious effort to obtain a comprehensive picture of nonbelief, including differing levels of certainty (i.e., atheists as certain nonbelievers, agnostics as uncertain nonbelievers). this review aims to provide an overview of the literature on psychological distress among nonbelievers and to identify other health states of nonbelievers that need further study.  methods we searched the psycinfo and pubmed databases, using the following search terms: atheis*, agnosti*, apostasy, apostate, and deconversion. the resultant group of articles was then further culled to limit articles to those with abstracts, written in english, and published  123  
  74  j relig health (2012) 51:72–86  from 1980 to the present, excluding books and dissertations. after reviewing all titles and abstracts, we selected articles that met our focus on symptoms and potential sources of psychological distress among religious nonbelievers. criteria for inclusion in this review were established as follows: studies were to be primary research and have some form of measurable or interpretable outcome. by mutual consensus, we eliminated articles from the pool because they did not meet our inclusion criteria. we then examined the reference lists of the identified articles for possible additional articles for inclusion.  results the results of our search are shown in fig. 1. after examining all studies for definitions and measurements of religious nonbelief, we divided the results into two broad categories: studies dealing with differences between religious nonbelievers and believers in levels of psychological distress (ten articles) and studies dealing with potential sources of distress among nonbelievers (four articles). psychinfo search  pubmed search  663 articles  328 articles  eliminated articles without abstracts, non-english articles, articles published before 1980, books, dissertations 349  eliminated articles not in english 260  eliminated articles based on review of titles and abstracts for focus on symptoms and potential sources of psychological distress among religious nonbelievers 2*  eliminated articles based on review of titles and abstracts for focus on symptoms and potential sources of psychological distress among religious nonbelievers 31  eliminated studies not primary research and/or without measurable or interpretable outcome 11  searched reference lists of 11 identified articles for additional articles 3  14 articles for review  fig. 1 results of literature search using the terms atheis*, agnostic*, apostasy, apostate, and deconversion. *these two articles were duplicates of two found in the psychinfo search  123  
  j relig health (2012) 51:72–86  75  definitions and measurements of religious nonbelief most of the articles defined religious nonbelief in terms of religious self-identification, such as atheism, agnosticism, no religion, religiously unsure, humanism, or rationalism (baker and cruickshank 2010; exline et al. 2011; hunter 1998, 2001; jenks 1986; mochon et al. 2011; schmidt et al. 2007; wilkinson and coleman 2010). atheists were variously defined as people who ‘‘... definitely did not believe in life after death’’ (lundh and radon 1998, p. 489); scored less than 4 of 7 on a scale of agreement with the statement, ‘‘i believe god exists’’ (exline et al. 1999); and/or affirmed the statement, ‘‘i don’t believe in god’’ (edgell et al. 2006). however, absolute disbelief in god did not always characterize atheists; for example, in one group of self-identified atheists, 94.9% did not believe in god, but the remaining minority indicated that they were unsure (james and wells 2002). agnostics were defined as spiritual but not religious (o’connell and skevington 2010) or uncertain about life after death (lundh and radon 1998). atheists and agnostics were occasionally grouped together as a single category of subjects (exline et al. 2011). nonbelieving jews ‘‘... identified themselves as being either agnostic or atheist, while at the same time maintaining their identification with the jewish community’’ (herzbrun 1999). certainly, many nonbelieving christians find themselves in a similar position of continued identification with the christian community; but none of the articles we reviewed explicitly mentioned such a group. conversely, some who do not feel part of a denomination may still hold religious beliefs. most articles from our sample measured religious nonbelief by means of a survey or questionnaire item labeling one’s religious identification as atheist, agnostic, or not religious (baker and cruickshank 2010; edgell et al. 2006; herzbrun 1999; hunter 1998, 2001; jenks 1986; o’connell and skevington 2010; schmidt et al. 2007). some studies used more standardized scales to determine belief status, such as the royal free hospital’s beliefs and values scale (wilkinson and coleman 2010) or a religiosity scale (mochon et al. 2011). one researcher asked subjects to rate how strongly religious they were (exline et al. 2011), whereas others examined the certainty of their sample’s nonbelief (james and wells 2002). others asked patients about their ideas regarding life after death (lundh and radon 1998). one study included multiple measures of nonbelief: scales of god belief, religious belief salience, religious participation, and feelings of alienation from god (exline et al. 1999). how nonbelievers differ from believers in levels of psychological distress differences between nonbelievers and believers in levels of psychological distress varied across the ten studies in this category, with two demonstrating more distress among nonbelievers, three suggesting less or equivalent distress among nonbelievers, and five producing mixed results (table 1). of the studies showing more distress among nonbelievers, one examined a sample of us undergraduate students and showed that nonbelievers had greater difficulty forgiving god (exline et al. 1999). another study collected questionnaire responses from undergraduate psychology students, a general social survey, and research advertisement respondents and demonstrated that nonbelievers have more anger toward god than do believers (exline et al. 2011). while it may sound paradoxical for nonbelievers to be angry with or withhold forgiveness from god, some nonbelievers have a previous history of religious belief; a small minority of self-defined atheists remain ‘‘unsure’’ about whether god exists; and these studies were structured in a way that allowed nonbelievers to respond to a hypothetical god rather than express actual feelings  123  
  nonbelief defined  nonbelievers: scored less than 4 of 7 on a scale of ‘‘i believe in god’’  self-identified religious affiliation: atheist, agnostic, none, atheist/ agnostic  author  exline et al. (1999)  exline et al. (2011)  results difficulty forgiving god nonbelievers reported significantly greater difficulty forgiving god than believers.  anger toward god studies 1, 2, 3: religious nonaffiliates reported more anger toward god than affiliates. study 4: religious nonaffiliates reported more negative feelings toward god than affiliates. study 5: did not involve nonbelievers  study design us undergraduate college students, summer–fall 1997, n 200 (4% atheist/agnostic, 4% no religious affiliation, 5% unsure)  study 1: national opinion research center general social survey, 1988, n 1481 (8% no religion) study 2: ohio undergraduate psychology students, n 189 (14% atheist/agnostic) study 3: ohio undergraduate psychology students, n 446 (12% agnostic, 7% atheist, 7% no religion) study 4: advertisement respondents, n 244 (6% no religion, 3% atheist/agnostic) study 5: no information on nonbelievers  measurement tools beck depression inventory beck anxiety inventory state trait anger scale blaine and crocker’s religious belief salience measure 17-item scale of religious participation 5-item scale of feelings of alienation from god 6 items measuring forgiveness of god, self, and others study 1: 7-item scale of anger toward god study 2: 10 items measuring emotion toward god; 10 items measuring cruelty attributions study 3: blaine and crocker’s religious belief salience measure; center for epidemiological studies—depression scale study 4: center for epidemiological studies—depression scale; satisfaction with life scale; impact of event scale; measure of physical symptoms study 5: did not involve nonbelievers  table 1 differences between nonbelievers and believers in levels of psychological distress  76 j relig health (2012) 51:72–86  123  
  negative beliefs about death increased catholic and atheist anxiety: death as pain and loneliness, death as failure, superstitious beliefs increased atheist anxiety: death as forsaking dependents ? guilt, death as courage decreased atheist anxiety: indifference to death affect and adjustment: death anxiety death depression scale: atheists and agnostics scored higher than religious stroop task: no anxiety difference between 3 groups for deathrelated words spiritual well-being compared between believing and nonbelieving jews both groups showed significant spiritual health, able to identify awe, tragedy, and a purpose in life. spiritual health did not preclude struggles around issues of faith.  cross-sectional study, atheists recruited from atheist/agnostic and secular organizations, n 303 (197 atheists)  swedish study, n 45 (15 atheists, 15 agnostics)  jewish study (interviews), 4 days-5 weeks, n 18 (9 nonbelievers)  the death perspective scale the death beliefs questionnaire the symptom interpretation questionnaire the health anxiety questionnaire the somatosensory amplification scale short scale epq-r (personality traits)  death depression scale stroop interference task  semi-structured interviews (face-to-face or email), including 10 questions on faith development and spiritual wellbeing  atheists: no definition included; 94.9% indicated no belief in god; remainder unsure  atheists: subjects who definitely did not believe in life after death agnostics: subjects who were uncertain about life after death  nonbelieving jews: identified themselves as agnostic or atheist, while maintaining identification with the jewish community  lundh and radon (1998)  herzbrun (1999)  james and wells (2002)  results  study design  measurement tools  nonbelief defined  author  table 1 continued  j relig health (2012) 51:72–86 77  123  
  123 quality of life study spiritual quality of life: lowest in atheists more important to agnostics than atheists: spiritual connection, meaning of life, faith, awe, and wholeness atheists and agnostics share: meaning in life and spiritual strength moderately important religious: lower negative feelings, better personal relationships than agnostics. levels of depressive symptoms no significant difference between all groups  british study, mailed questionnaires over 3 months, n 285 (122 agnostic, 55 atheist)  british study, november 2007– february 2008, n 471 (130 atheists, 104 agnostics)  italian study, 1-6 days after pope’s death, n 526 (76 atheists)  british case series (interviews), atheists recruited from the british humanist association, n 19 (11 atheists)  world health organization quality of life—spiritual, religious, and personal beliefs questionnaire  63-item questionnaire: demographics depression-happiness scale (dhs) salience scale measurement of frequency of religious practices scale analyzing beliefs about treatments for depression modified version of (2004) questionnaire of luminet et al.  beliefs and values scale hospital anxiety and depression scale  agnostics: ‘‘spiritual but not religious’’ atheists  self-reported religious affiliation: atheist, agnostic  self-identified religious affiliation: atheist  self-identified religious affiliation: atheist (score less than or equal to 26 on beliefs and values scale)  o’connell and skevington (2010)  baker and cruickshank (2010)  schmidt et al. (2007)  wilkinson and coleman (2010)  coping in old age all participants coping well with old age, judged by lazarus’ eight principles of successful aging  psychological reactions to the death of pope john paul ii atheists: less intense negative emotions (sadness, fear, anxiety, anger, guilt) and more boredom compared with catholic believers  results  study design  measurement tools  nonbelief defined  author  table 1 continued  78 j relig health (2012) 51:72–86  
  nonbelief defined  self-reported religious affiliation: atheists, agnostics, no religious affiliation/none  author  mochon et al. (2011)  table 1 continued results certainty of belief and happiness 47.3% of religious less happy than atheists 21.9% of religious less happy than agnostics 14.4% of religious less happy than those who report no affiliation the highest levels of well-being result from the highest levels of certainty in one’s belief system.  study design online study, n 6465 (133 agnostics, 68 atheists, 593 no religion)  measurement tools religiosity scale by blaine and crocker (1995) 7 measures of well-being  j relig health (2012) 51:72–86 79  123  
  80  j relig health (2012) 51:72–86  toward god. certain perspectives on death, such as guilt over leaving dependents behind, uniquely correlated with death anxiety among a sample of atheists compared with catholics (james and wells 2002). in a swedish study, atheists and agnostics scored higher on the death depression scale (which is actually a more representative measurement of anxiety than depression) than did believers, indicating greater death anxiety in the nonbelieving groups (lundh and radon 1998). during a series of semi-structured interviews, jews who had lost their faith described a sense of isolation, a desire to conceal their nonbelief from the jewish community, and the perception that they were alone in their distress. (herzbrun 1999) in a british study that collected responses to the world health organization quality of life—spiritual, religious, and personal beliefs questionnaire over 3 months, religious people reported lower negative feelings in general and better personal relationships than agnostics, and atheists had a lower level of spiritual quality of life than believers and agnostics (o’connell and skevington 2010). in contrast, seven articles pointed out instances in which nonbelievers experienced comparable or less distress than their believing counterparts. for example, no significant difference in depressive symptoms was noted between groups of atheists, agnostics, christians, and muslims among british respondents to a questionnaire (baker and cruickshank 2010). one study of atheists recruited from atheist/agnostic and secular organizations showed that an attitude of ‘‘indifference toward death’’ correlated with less anxiety about death among atheists than among believers (james and wells 2002). although atheists and agnostics scored higher than believers in a swedish study that used the death depression scale, the same study found no difference between the groups’ anxiety levels when measured using a stroop interference task (lundh and radon 1998). also of note, italian atheists experienced a less intense negative emotional reaction to negative religious news (e.g., death of pope john paul ii) than did believing catholic respondents (schmidt et al. 2007). among 19 british interviewees, atheists and believers were found to cope equally well with the challenges of old age, by compensating for losses, actively engaging in purposeful striving, and retaining positive self-regard (wilkinson and coleman 2010). despite experiencing some struggle centering on their disbelief, a sample of nonbelieving jews were as spiritually and psychologically healthy as their believing counterparts, as measured by their sense of awe, purpose in life, and awareness of tragedy. (herzbrun 1999). british atheists and agnostics that responded to a questionnaire on spiritual quality of life stated that ‘‘meaning in life’’ and ‘‘spiritual strength’’ were moderately important to them. (o’connell and skevington 2010). several of these articles demonstrate that strength of conviction, be it atheistic or religious, correlates with improved psychological health. degree of inner conviction is associated with degree of well-being: for example, strong atheistic beliefs are comparable to strong religious beliefs in helping people cope with the challenges of aging (wilkinson and coleman 2010). christians with high levels of religious saliency have significantly lower levels of depressive symptoms. (baker and cruickshank 2010) just as greater conviction correlates with better health, less certainty of belief has been associated with decreased well-being. religious adherents with low certainty of belief may be less happy than nonbelievers, with 47.3% of religious respondents to an online study reportedly less happy than atheists, 21.9% less happy than agnostics, and 14.4% less happy than those with no religious affiliation (mochon et al. 2011). these studies demonstrate a clear correlation between strength of conviction in one’s religious (or nonreligious) worldview and psychological well-being, with both the most and least religious individuals experiencing the best health. this literature has some major limitations. several of the studies had small samples (lundh and radon 1998; herzbrun 1999; wilkinson and coleman 2010), and others had  123  
  j relig health (2012) 51:72–86  81  relatively low participation rates by nonbelievers (exline et al. 1999, 2011). in addition, contradictions between studies of death anxiety (james and wells 2002; lundh and radon 1998) and spiritual quality of life (o’connell and skevington 2010; herzbrun 1999) may be due to a lack of consistency in the measurement tools used to quantify those variables. despite these limitations, several robust points emerge from the literature. a clear association has been demonstrated between nonbelievers and increased anger at (exline et al. 2011) and nonforgiveness of (exline et al. 1999) god. multiple studies demonstrate that those with the greatest strength of conviction in their religious (or nonreligious) worldview experience the greatest psychological health (wilkinson and coleman 2010; baker and cruickshank 2010; mochon et al. 2011). potential sources of psychological distress in nonbelievers that nonbelievers are generally viewed more negatively than believers by those around them is demonstrated by four studies in our sample (table 2). these negative perceptions are potential sources of distress for nonbelievers, as research has linked negative societal attitudes toward specific groups (i.e., nonbelievers) with social exclusion (edgell et al. 2006), inequality (edgell et al. 2006), and the internalization of negative perceptions (jenks 1986). college-age believers consistently evaluated christians more highly than atheists, even when they saw examples of christians behaving negatively (e.g., ignoring, cheating, or refusing to help the participant) and atheists behaving positively (e.g., helping or being generous toward the participant) (hunter 1998, 2001). university students also perceived atheists less favorably than catholics in terms of moral rightness, education, social status, political views, parenting styles, life satisfaction, and control over one’s life (jenks 1986). in response to a nationwide telephone survey, a large number of americans stated that they were likely to disapprove of their children marrying atheists, and many felt that atheists were the group ‘‘... least likely to share their vision of american society’’ (edgell et al. 2006, p. 212). our literature search yielded only one potential source of psychological distress among nonbelievers: perceptions of nonbelievers by others. of the four studies examining perceptions of nonbelievers by others, three restricted participation to university students (hunter 1998, 2001; jenks 1986), limiting the generalizability of their results. despite this shortcoming, all four studies were consistent in their findings: society at large perceives nonbelievers more negatively than believers.  discussion regarding levels of psychological distress, nonbelievers are more likely than believers to struggle with anger toward god (exline et al. 2011) and difficulty forgiving god (exline et al. 1999). however, in terms of responding to the death of a public religious figure (schmidt et al. 2007), coping with the challenges of old age (wilkinson and coleman 2010) and overall happiness (baker and cruickshank 2010), they are just as well or better off than their believing counterparts. conflicting positives and negatives arise when nonbelievers are compared with believers for death anxiety (james and wells 2002; lundh and radon 1998) and spiritual quality of life (o’connell and skevington 2010; herzbrun 1999). the mixed picture that emerges may be due to inconsistencies in the measurement of nonbelief, differing measures of distress, or the variety of sample sizes of each study.  123  
  82  j relig health (2012) 51:72–86  table 2 sources of psychological distress among religious nonbelievers author  nonbelief defined  measurement tools  study design  results  hunter (1998)  atheists described in fictional vignettes  7-point likert scale self-description questionnaire iii  university of otago student members of christian union organization, n 141  perceptions of atheists by others: regardless of the behavior described in the vignettes, participants evaluated christians higher than atheists.  hunter (2001)  atheists described in fictional vignettes  7-point likert scale self-description questionnaire iii  new zealand university student members of university christian union organizations (protestant), n 180  perceptions of atheists by others: respondents evaluated (a) in-group [christian] targets who behaved (?) more highly than outgroup [atheist] members who behaved (?), and (b) in-group (-) more highly than out-group (-)  jenks (1986)  atheists: one of four distinct social groups evaluated in a questionnaire  questionnaire: estimates on characteristics of republicans, catholics, homosexuals, and atheists; their own positions on various issues  us undergraduate sociology students, n 146  public perceptions of atheism as deviant: atheists perceived as deviant in terms of right/wrong, education, social status and political views, parenting styles, life satisfaction, and control over one’s life  edgell et al. (2006)  atheists: one social group evaluated as part of a telephone survey  national telephone survey: (1) this group does not at all agree with my vision of american society, (2) i would disapprove if my child wanted to marry a member of this group in-depth interviews in 4 us cities  the american mosaic project 2003 national (telephone) survey data, summer 2003, n 2081  perceptions of atheists by others: 39.6% of americans say atheists are ‘‘least likely to share their vision of american society’’ (39.6%) 47.6% of americans are likely to disapprove of their children marrying atheists (47.6%)  interestingly, there appears to be a correlation between strength of conviction in one’s religious (or nonreligious) worldview and psychological well-being (wilkinson and coleman 2010; baker and cruickshank 2010; mochon et al. 2011). this correlation is supported by findings connecting greater existential certainty with decreased depressive symptoms (riley et al. 2005). relative to patients self-labeled as spiritual or religious, patients unsure about religion had the highest rates of drinking and the least amount of improvement after being treated in alcoholics anonymous (tonigan et al. 2002). similarly, subjects deconverting  123  
  j relig health (2012) 51:72–86  83  from a place of religious conviction to the unsure worldview of apostasy reported poorer quality of life than individuals who retained their religious convictions (brinkerhoff and mackie 1993). this seems to indicate a bimodal relationship between religiosity and health, with the greatest health experienced by the most and least religious individuals. although believers and nonbelievers tend to be grouped together as static groups, these data indicate that not all believers (or nonbelievers) are alike and that strong atheists appear to enjoy the same psychological benefits as strongly religious individuals. regarding potential sources of psychological distress among nonbelievers, we found four studies that demonstrated a widespread negative bias against nonbelievers (hunter 1998, 2001; jenks 1986; edgell et al. 2006). one indicated that this level of disapproval placed atheists at the top of americans’ list of problematic groups, representing levels of public rejection higher than that of muslims in post-9/11 america (edgell et al. 2006). while recent decades have seen a marked improvement in societal attitudes toward diverse racial and religious minorities, atheists continue to fall short in terms of public acceptance. such a level of nonacceptance is certainly a potential source of distress for nonbelievers as they attempt to integrate into society. promisingly, some research has shown that, as religious believers perceive an increase in atheist prevalence, anti-atheist prejudice decreases (gervais 2011). additional research needs to explore moderators of these negative beliefs, ways such attitudes impact behaviors, and the effects that these common perceptions have on the psychological well-being of nonbelievers. our literature review uncovered only one potential source of psychological distress among religious nonbelievers (negative perceptions of nonbelievers by others), but other sources might certainly exist. interactions with believing family and friends, decisions regarding the rearing of children by mixed believer/nonbeliever couples, doubts about one’s disbelief, and the search for meaning in life without a religious system are all potential mediators of psychological distress for nonbelievers that would be interesting to investigate. this systematic review shows that various forms of psychological distress are experienced by religious nonbelievers. however, relatively little has been done to study nonbelievers, and we know little about their psychological health. there is a need for more studies and conceptual models to guide our understanding and care of this overlooked population. with an ever-increasing number of nonbelievers in the united states (pew forum on religion & public life 2009), their health deserves increased scientific attention, with the same rigor and sophistication that the study of those with religious belief has received (koenig and larson 2001). the work of pargament and others provides a dynamic model for understanding the psychological struggles of religious believers and may be a useful starting point for development of a model of struggles among nonbelievers (pargament et al. 2005). the model of pargament et al. divides spiritual struggles into three categories: intrapsychic struggles of doubt, interpersonal struggles of cooperation, and the divine struggles of understanding god. this approach provides a nuanced view of the complex phenomenon of religious belief and its associated struggles. a similar model may be helpful in improving our understanding of religious nonbelievers. rather than viewing nonbelief as a static endpoint, nonbelief and the associated psychological stresses may be a more dynamic, multifaceted process, including: (1)  interpersonal struggles: nonbelievers must learn to live, work, and cooperate with others who maintain systems of religious belief. the difficulty of achieving a full, cooperative equality has been demonstrated by the literature, which shows persistent negative perceptions of nonbelievers by others (hunter 1998, 2002; edgell et al. 2006; jenks 1986).  123  
  84  j relig health (2012) 51:72–86  (2)  intrapsychic struggles: just as believers may doubt the existence of god or the truthfulness of religious claims, nonbelievers may doubt their decision to live without religion or struggle to find their moral compass. studies demonstrating anger and difficulty forgiving god (exline et al. 1999, 2011) and difficulty adjusting to a nonbelieving worldview (herzbrun 1999) support the idea that nonbelievers have unique intrapsychic struggles. divine struggles: although most nonbelievers have jettisoned traditional beliefs about god, many still struggle to find meaning in life (o’connell and skevington 2010), maintain awe in their existence (herzbrun 1999) and face aging and death with strength and courage (james and wells 2002; lundh and radon 1998; wilkinson and coleman 2010).  (3)  we believe that application of the model of pargament et al. to struggles of nonbelief will enable healthcare researchers to more accurately and uniformly describe the psychological stressors unique to nonbelievers and their health care. some nonbelievers may be comfortable with their nonbelief, while others may struggle with it. it would be a mistake to assume that nonbelief is a fixed and final state for everyone. this review has some limitations. the number of studies that met criteria for inclusion was low. we focused on psychological distress among nonbelievers; it is possible that a broader approach (e.g., nonbelievers and health) would have yielded a greater number of articles for review. additionally, the studies we selected were from dissimilar scientific disciplines, including psychological, medical, and sociological literature. in addition to the limitations of our review, the literature itself has some limitations. most articles in our sample included definitions and measurements of religious nonbelief. the definitions provided were generally not detailed or thorough, and the measurements used were not consistent or standardized. clear, consistent definitions of nonbelief should be included in future studies to ensure that results are interpreted within the correct context. descriptions of and reasons for choosing measurement tools for quantifying nonbelief would add depth and reproducibility to further research and might prove particularly important in studying the strength of conviction in one’s beliefs.  conclusion religious belief is a complex component of individual psychological well-being. though higher levels of religiousness among people with a basic level of religiousness may contribute to individual well-being, it does not follow that nonreligiousness is necessarily deleterious to psychological functioning. with religion receiving greater consideration in the psychology literature than ever before, it is our hope that efforts can be made to increase attention to the opposite side of the belief coin. religious nonbelievers have stresses and struggles unique to their situation. the use of a dynamic model of nonbelief analogous to the model of spiritual struggle of pargament et al. (pargament et al. 2005) may improve the depth and usefulness of future literature examining the psychological well-being of nonbelievers. acknowledgments this work was partly supported by the va hsr&d houston center of excellence (hfp90-020). the views expressed reflect those of the authors and not necessarily those of the department of veterans affairs/baylor college of medicine.  123  
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secondary_title_index: mental health, religion &amp; culture
title_index: the lived experience of spiritual abuse
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       mental health, religion & culture vol. 14, no. 9, november 2011, 899–915  the lived experience of spiritual abuse david j. ward* social worker, private practice, brisbane, australia (received 27 january 2010; final version received 27 october 2010) over the years there has been considerable research investigating the controversial issues of cult recruitment, ‘‘mind control’’ and post-group difficulties of ex-members from a variety of religious groups. however, the less-well-defined phenomenon of ‘‘spiritual abuse’’ is still under-researched as a specific phenomenon. this is particularly evident in the lack of studies exploring the subjective, internal experience. this study reports on the lived experiences of six individuals who left five different religious groups that were essentially judeo-christian in their orientation. an interpretative phenomenological analysis (ipa) revealed six core themes throughout the participant narratives. they consist of ‘‘leadership representing god,’’ ‘‘spiritual bullying,’’ ‘‘acceptance via performance,’’ ‘‘spiritual neglect,’’ ‘‘manifestation of internal states,’’ and ‘‘expanding external/internal tension.’’ these are offered as a foundation to answer the question what can be described as the lived experience of spiritual abuse? the findings suggest that spiritual abuse is a multi-faceted and multi-layered experience that is both process and event, affecting the bio/psycho/social and spiritual domains of an individual. keywords: spiritual abuse; experience; cults; phenomenology  introduction spirituality is an extremely diverse and complex phenomenon, both within and across various traditions (rose, 2007). the psychology of religion as a field of study has experienced significant growth over the last quarter century (emmons & paloutzin, 2003). however, there remains little written about the phenomenon of spirituality that has turned toxic; that is, via a range of psycho-social processes, it ceases to be beneficial to the adherent, but instead becomes a tool to inflict psycho-spiritual damage. while there is a vast body of literature that has examined the cult phenomena, extremely little has been written on spiritual abuse in its own right. thus far, much extant material has revolved around various (psychological) models of cultic influence (e.g., hassan, 1988; lifton, 1961; singer, 1995). these models remain conceptually and therapeutically useful in understanding complex group dynamics. however, they essentially focus on what causes group behaviour and what are the effects of the causes. while the focus on observable behaviour is useful, the models offer little insight into the subjective states of those affected. apart from references to emotion manipulation, these empirical frameworks offer little by way of exploring internal processes and the meaning ascribed. *email: david@buildingblocks.net.au issn 1367–4676 print/issn 1469–9737 online s 2011 taylor & francis http://dx.doi.org/10.1080/13674676.2010.536206 http://www.tandfonline.com  
  900  d.j. ward  conversely, the field of phenomenology asserts that should one want to objectively know something, it must journey via our subjectivity. moran (2000) writes ‘‘ . . . the whole point of phenomenology is that we cannot split off the subjective domain from the domain of the natural world as scientific naturalism has done. subjectivity must be understood as inextricably involved in the process of constituting objectivity’’ (p. 15). objectivity and subjectivity then, are intertwined and the desire behind this research is that the exploration of subjectivity shall add a more holistic insight into the phenomenon. the qualitative study that follows was initiated after two clinical observations by the author over many years in supporting ex-members from a range of groups. firstly, while acknowledging that not all ‘‘unorthodox’’ groups or new religious movements harm their membership (namini & murken, 2009), there are groups that clearly do so. some are indeed toxic, with clearly physically and emotionally abusive practices (asser & swan, 2004; lalich, 1997; stein, 1997). the second observation is that harm that can be linked to group membership generally occurs on a continuum for a multitude of reasons and a clear-cut ‘‘normality versus pathology’’ is unhelpful (buxant, saroglou, casalfiore, & christians, 2007). however, while the ‘‘true religious cults’’ (in the pejorative sense) are arguably spiritually abusive, the thesis of this paper is that not all spiritual abuse is found in a ‘‘cult.’’ clinical experience suggests that some groups, while displaying concerning behaviours toward its membership, would be hard pressed to warrant the term. nonetheless, there are ex-members who were subjected to boundary violations by the leadership and who experienced an array of emotional and existential difficulties as a consequence. to what extent the group process was responsible for any residual issues is open to debate. this research was also initiated after noting three observations in the literature. firstly, many studies that explore the experiences of ex-members in controversial groups tend to be firmly empirical in orientation (i.e., amendros, carrobles, & rodiguez-carballeira, 2007; buxant et al., 2007; martin, langone, dole, & wiltrout, 1992). popular psychological models that are used to explain toxic groups also tend to focus on the behavioural dynamics (hassan, 1988; lifton, 1961; singer, 1995). a considerable portion of the literature has investigated how groups control and influence members, recruit new members or has focused on the brainwashing controversy (zablocki & robbins, 2001). secondly, it appears that the internal, subjective experience of ex-members has not been researched as vigorously. while the more positivist research is useful in exploring a plethora of psycho/social/spiritual variables, i argue that it is equally important to explore the subjective experience. the elucidation of internal experience has been historically foundational to many helping professions and has been argued to be a prerequisite for any therapeutic relationship (hansen, 2005). research that explores the subjective meaning of an event also appears to be increasing. for instance, in their study of the subjective experience of parkinson’s disease, bramely and eatough (2005) have noted that the meaning given to the physical illness rather than solely the observable symptoms can often determine emotional well-being. in light of the propensity for quantitative methodologies in investigating the personal experience of ex-members and the inclination in the literature to focus on the brainwashing/recruitment controversy, it is understandable that the subjective experience has been relegated to secondary importance. interestingly, a review of the literature suggests there is an expanding awareness of spirituality within the therapeutic domain by a range of professions (powers, 2005). finally, research that explores this topic tends to equate ‘‘cult abuse’’ with ‘‘spiritual abuse’’ (i.e., langone, 1993) or investigates the spiritual effects of childhood trauma (e.g., bland, 2001). admittantly there is overlap between the two concepts, such as various  
  mental health, religion & culture  901  boundary violations, coercive or unethical behaviour and resultant emotional distress. however, as this paper suggests, the spiritual aspect of the abuse is usually the core experiential feature for the exiting member. in other words, there is no consensual definition of ‘‘spiritual abuse’’ and like the term ‘‘cult,’’ could be defined in various ways depending on the methodology of the researcher. the heterogeneity of contemporary groups also makes it challenging (bohm & alison, 2001). such definitional ambiguity is not uncommon however, and this parallels other social and behavioural phenomena where despite much examination, there remains considerable debate as to its character (e.g., follinstad & dehart, 2000; haugaard, 2000). this research then, aimed to explore an elusive, difficult-to-define phenomenon; one that is intensely personal and subjective. given that spirituality is a deeply personal and variable phenomenon, deciding at what point it becomes toxic is problematical. despite this, there have been some moves to address the issue. for example, johnson and vanvonderen (1991) argued that: spiritual abuse is the mistreatment of a person who is in need of help, support or greater spiritual empowerment, with the result of weakening, undermining or decreasing that person’s spiritual empowerment. (p. 20)  more recently, wehr (2000) suggested that, ‘‘spiritual abuse is a misuse of power in a spiritual context’’ (p. 20). from what literature is available, the primary component appears to centre on a misappropriation of power by the leadership culminating in a range of grievances. again, the parallels with certain sections of the cult literature become apparent. consequently, for the purpose of this study, spiritual abuse was defined as: a misuse of power in a spiritual context whereby spiritual authority is distorted to the detriment of those under its leadership.  this was a necessary starting point from which to initiate the study and the above definition was used in the recruiting of participants. obviously, only those individuals who could identify with the above definition volunteered for the research.  methodology given purpose of the research was to explore the internal, meaning-making experience of spiritual abuse, the theoretical guide for this study was important. interpretative phenomenological analysis (ipa) constructed by smith (1996, 2003, 2004) acted as this guide. ipa sustains a phenomenological core by seeking to understand human experience. it also involves a detailed examination of the lifeworld of the individual and aims to gather a description of the person’s perceptions of an object or account (smith, 2003, p. 51). having its origins in the hermeneutic tradition, a wide use of available literature is encouraged so as to develop a richer picture of the experience. such an approach was adopted for this study with a small sample size of six, but with an attempt to seek out a variety of individual backgrounds so as to develop a more complex picture of the phenomena.  participants at the outset of the study, it was determined to involve participants from a variety of groups with an even gender mix. this would offer a richer account of the experience studied. sample size within ipa is dependent on the topic under discussion; however,  
  902  d.j. ward  it tends to favour small numbers (smith, 2004). via a snowball sampling, four female and two males between 39 and 77 years of age (age 1⁄4 56.1 years) were willing to be involved. the average time spent in their respective group was 19.3 years with an average of 12.5 years out of the group. one male and female were married and came from the same group. the five groups from which the participants exited could be described as ‘‘bible-based’’ groups; that is, doctrine and practice were loosely christian in orientation.  method given the potential for individuals to be emotionally vulnerable, a number of ethical domains were considered to minimise undue distress in the interviews. firstly, there was a telephone interview to ascertain general suitability. this was followed by a face-to-face interview to further assess emotional stability. finally, counselling agencies were also notified should any of the participants leave the study and require psychological assistance. over the years, the author has noted the distress of some ex-members and subsequently, steps were taken to enhance the emotional safety for the participants as they recounted their story. data collection was via open-ended interviews with the purpose of collecting participant interpretations of their experience (kvale & brinkmann, 2009). the in-depth approach was used for two primary reasons. firstly, it allowed the participants to choose what material to disclose and to what extent. secondly, to impose a more rigid structure may have created an unhelpful linear time frame for the participants’ experiences. by using an open structure, the participants were encouraged to pause or expand on their experiences as they arose in consciousness. this also allowed participants and researcher to explore personal meaning in a collaborative way. tape recording was used as opposed to video so as to reduce intrusiveness. to ensure the interview schedule gathered useful information, a pilot interview was held with an independent individual who identified as being a victim of spiritual abuse. productive information was collected and so the schedule remained unchanged. the data from that interview however, were not used in the analysis. given that the aim of the research was the exploration of subjective experience, the interview schedule was designed so as to allow the participants to share their experience as unencumbered as possible. while the questions were broad in scope, emerging themes in the interviews were probed and developed as fully as possible. all participants were articulate in the retelling of their experiences and were keen to share. a ‘‘good’’ interview has few fixed criteria; as much a craft as it is science (kvale & brinkmann, 2009).  findings the analytic process within ipa involves the individual transcript being read numerous times so as to be fully acquainted with the material. patterns of meaning are then distilled within the transcript and a preliminary list of sub-themes is then produced. in this phase, there were a range of sub-themes that described the lived experience of the participants such as ‘‘collective consciousness,’’ ‘‘family impact,’’ ‘‘use of fear and guilt,’’ ‘‘image of god,’’ ‘‘social isolation’’ and ‘‘submission to authority.’’ these patterns of meaning are then investigated across all the transcripts along with the use of existing literature to further elaborate the themes. these broad themes were later organised into categories that  
  mental health, religion & culture leadership representing god  (powerful symbolic authority)  spiritual bullying  (manipulative behaviour of the leadership)  acceptance via performance  (approval of the leadership/group through obedience)  spiritual neglect  (detrimental acts of omission by the leadership)  the expanding external/internal tension  (dissonance between one’s inner and outer worlds)  manifestation of internal states  (the bio/psycho/spiritual repercussions of the abuse)  903  figure 1. six core themes as generated from participant transcripts.  distilled the experience into six core themes that each of the six participants encountered while in their respective group. these themes are outlined in figure 1. the above six themes are illustrated below with verbatim narrative from the transcripts along with some brief comments. this is followed by a more detailed conceptualisation. material in italics represents strong emphasis by the participant as he or she recounted their story.  leadership representing god during the interviews, all the participants explained the idea that the leadership of the group represents the highest spiritual authority. it was believed that the leadership were placed in their position by god and therefore spoke authoritatively on all areas of faith and life. it followed that if the leadership represented the highest authority (god), then essentially to obey them is to obey god; to disagree is to be in opposition to god: you can’t admit that you don’t believe something that comes out in a publication, you can’t have a different view on something that is being said from the platform. if you do, you are in opposition to god. (sue)  the importance of leadership as god’s mouthpiece was recounted by mark and liz: i challenged him after he made a statement and i said ‘‘are you saying to us here, that when you speak, you speak the infallible word from god’’? he looked at me and said ‘‘yes i do. i am speaking an infallible word from god’’. (mark) he [the leader] would come up with spontaneous prophecies and prophecy that god was saying ‘listen to voice of your father david, for he is righteous’, so he would prophesise his own affirmation of himself you know. (liz)  given the deep symbolic power of leadership representing the divine, to question them is by implication questioning god. consequently, there is the assumption that the leadership is more spiritually advanced than the rest of the group. for example, megan expressed the notion that they were ‘‘forced into immaturity’’: ok . . . here is a big one, spiritual abuse by being forced into immaturity. in other words, we were never given permission to grow; we were always hampered, or hindered. for example, if i wanted to grow in hearing more from god i was always told ‘‘goodness me! where did you come from? what on earth gives you even the grey mist of idea that you even could possible pursue that! god doesn’t talk to you! you know . . . he only talks to us, the leadership’’.  liz expressed a similar thought as she recounted the punitive parent-like treatment of the leadership: you know, our minds were spinning with this indoctrination all the time it was all they were allowed to think and if we thought anything else we would be sharply rebuked or punished or  
  904  d.j. ward  ostracised and of course they make you so co-dependant. they literally just made us children, we regressed and the way they would treat us was as children.  each of the participants experienced this unequal power dynamic. most felt as mark did that it was reflective of the leader’s personality: it’s something that man invented because the man at the top, [leader] i believe is a megalomaniac. he’s quite unbalanced. he is almost like hitler, and these characters throughout history who demand complete obedience and they become obsessive about it so they don’t know how to trust anyone. (mark)  mark’s comment regarding the leadership’s obsessionality and distrust of outsiders reveals a religious fundamentalism that sees the world only in polarities, or an ‘‘us versus them’’ mentality. corollary to such compliance is the expectation that self-directed decision making is frowned upon as megan explains: permission needed to travel interstate. i needed permission to visit other churches which had to be within our network of course. i needed permission to visit other small groups within our church. it was just extraordinary. i had to get permission to go to a family function instead of a church function. i had to get permission to go down to the coast to visit my parents in law and explain every little thing, where i was, why i was there and why i didn’t go to church activities. (megan)  as megan remembers how little she could do without the leader’s permission, one starts to get a sense of the dominating control found in spiritual abuse. this control extended to relationships both within and without the group. the narratives above suggest that the combination of discouragement of self-directed action, the pressure to obey and the belief that the leadership’s directives originate from god, have painful and far-reaching consequences. this was particularly so for the individual’s sense of worth: they somehow or other ruled you by making you feel that you are a failure and the only way to not be a failure was to depend on them more, trust them more, give yourself completely to them more because they had a divine revelation, they had a divine line between them and god which was greater than any connection you might have had with god. you had to hear from god through them. (ann)  ann’s narrative indicates a spiralling double bind. the sense of failure that the leadership itself induced can only be ameliorated by more dependency. this parallels another layer of experience that the participants reported; that of a regressing to an earlier developmental stage. for example, this was megan and liz’s awareness of ‘‘forced immaturity’’ and ‘‘regression.’’ this potentially creates an even stronger tie with the leadership. this reveals some of the more subtle aspects of spiritual abuse whereby an individual discovers he or she is in a psychological trap that is difficult to make sense of and even more difficult to extract oneself from. for others such as sue, it has equally serious consequences such as the turning of a blind eye to domestic violence: there are a lot of women that get abused because you are supposedly in subjection to your husband. even if you are doing the wrong thing, because he’s the head of the household you have to take it . . . . you can’t even get a restraining order because you are not allowed to take your brother to court. you have nowhere to go, if you take it to the elders . . . he can be more angry with you then he was in the first place because he has got into trouble. (sue)  
  mental health, religion & culture  905  threatening children is also not uncommon in domestically abusive situations. for sue this too was a tremendous fear, particularly in terms of whether her children would survive the end of the world as taught in her apocalyptic group: also the thing of if i didn’t live god’s way then my children would pay the price and they would die an early death so there was a mixture of emotions going in there . . . .it engulfed me and i thought i can’t take on anymore and because they kept on saying that, the end is so close that your children’s lives are at risk, i chose that i had to give my energy to that, rather than to finish my studies and follow my career in architecture. (sue)  once again the language used by the participants has helped to appreciate the potent forces behind this theme. the control and domination of the leadership become ‘‘god’s way.’’consequently, sue experienced a ‘‘mixture of emotions’’ that threatened to ‘‘engulf’’ her to the point where she relents and forgoes personal welfare such as vocational interests. powerful imagery such as being ‘‘engulfed’’ is an informative window into the internal experience of spiritual abuse. the notion of leaders representing the divine also had repercussions for how the participants subsequently viewed spirituality after they departed the group. for one respondent, a marked sensitivity was generated: i don’t have anything to do with the bible. i don’t have any . . . hate for god or anything against the bible, i just . . . don’t have anything against anybody else having anything that they believe but i am extremely sensitive to anybody trying who force their beliefs on me (sue).  for another, there were deep feelings directed towards god: as far as spirituality goes, for the next few years i was deeply depressed and very angry with god and i would cry myself to sleep every night just telling him how angry i was with him (liz).  the difficulty for ann was at a more relational and personal level: finding trust again and being able to love and accept, and allow yourself to be loved and accepted again is a hard thing.  interestingly for mark, while he felt the experience did not cloud his perceptions regarding god, a sense of apprehension remained: as i think about it now, i am pretty sure i didn’t buy it, it didn’t make god some kind of a terrifying person but it certainly did do something to put a fear in me of those men.  the above highlights that individuals who have encountered spiritual abuse often share common experiences. however, they also make sense of the experience as unique individuals, interacting with their own personality and history. in summary, a primary theme as told by all the participants is that their respective leaderships represented the divine. the leadership had to be obeyed in order to receive validation and avoid recrimination. since the leadership is above reproach, any mistreatment is justified due to divine representation. as the rest of the themes below suggest, the notion that the leadership represented the divine was the catalyst for other ill-treatment.  spiritual bullying due to the fact that the leadership represented the highest spiritual authority, they were in a position to dictate to the group whatever standards of behaviour they deemed  
  906  d.j. ward  appropriate: and incredible bullying and recrimination around this leaving, people who left and [the leader] himself of course wrote many letters on backsliders and their fate and if you ever heard of anything bad happening to any backsliders he would make a big deal out of it and ‘this is what god does to those who leave’ and all that kind of stuff. (liz) in reflection, you are robbed of your right to be yourself. i haven’t used that word before it is just something that has come into my vocabulary now about it all. but we were seduced. in a matter of fact, a word that i have used and i don’t know if i have used it here before, two words that i have used and i noticed it here in my notes here. that on reflection, i felt that we were violated because emotionally, spiritually, psychologically we were robbed of the right to be ourselves, and we were violated. i hope this is not too strong a word, but i felt in that sense we were raped. we really were. (mark)  due to the fact that the leadership were subject to no accountability themselves, opportunities for bullying behaviour emerged. language such as being ‘violated’ and ‘raped’ give some sense of the deeply personal nature of the mistreatment. noteworthy also were the threats of doom should the member consider leaving or to any who did leave, they were considered ‘‘backsliders.’’  acceptance via performance each of the participants in the study experienced what one participant termed ‘‘love based on performance.’’ that is, a spiritually abusive milieu is a performance-based system where ones’ worth is measured only in terms of productivity: i genuinely feared that my children were going to pay the price and die if i couldn’t live up to god’s expectations. (sue) i just pushed myself and pushed myself to do the best i could. (liz) they somehow or other think that if you don’t twitch the way they twitch, and move the way they move you are not loyal to them. being in it was continually like a soul searching, of flagellating of oneself because you just weren’t coming up to their standards and it just ground you, ground you, ground you into the dust. (ann)  note that the acceptance via performance is fear-based. consequently, there is a relentless pursuit to perform. as a result, there was also a ‘soul searching’; a flagellating of oneself’’ to ensure no recriminations by the leadership.  spiritual neglect thus far, the concerns of the ex-member have been associated with emotional manipulation and hurtful acts by the leadership. however, the extensive quote below summarises the experiences of the other participants that speaks of acts of omission: if you asked anybody that was not within the group [for help] it was tantamount to a slap in the face to god, because even medical help was complicated because . . . we didn’t have anyone in the medical profession within our group. my dad was a doctor so that was fortunate because it meant i could go to him and he came under the auspice of family help, but it is a really terrible thing. we had in our group people who had psychotic episodes we had an inordinate incidents of bipolar, we had incidents of psychotic depression, we had terrible incidents of bulimia and anorexia and terrible incidents of substance abuse and sex and relationship abuse in our young people. we had a terrible incident of suicide, we had marital break ups, of such a terrible percentage, but of course you see if you had marriage problems you were kicked out of the church because you were not walking with god because god was  
  mental health, religion & culture  907  punishing you and that is why you had marriage problems, so of course they would separate outside of the church so within the church it always looked like we had a really good record, but the truth is you would always kick out, kick people out, so if anyone started to go off rails or they started to become emotionally unstable or they had these sort of aberrant problems and they would all be told ‘‘now separate yourselves from us because you are not pure or you’re not perfect’’. (megan)  the above was a common experience among the participants. there were many situations where a group member experienced a range of emotional or physical conditions that were not adequately addressed by those in a position to help. in fact, rather than refer to a physician or a mental health professional, the individual concerned was seen to be slipping spiritually should he or she acknowledge any difficulty or went outside the group for help. as the participant explained above, some of these difficulties were extremely serious; only for the person to be neglected at best, or blamed at worst.  the expanding external/internal tension another theme that the participants expounded was the tension between their inner and outer worlds. at the outset of group membership, each person was able to suppress their individuality and emotional pain. however, each shared how the suppression of their individuality could not be maintained indefinitely. the demands of the group milieu, coupled with the developmentally normal drive to express individuality, eventually collided: i remember this one day where there was this group of us together and we had all been keeping up the ‘kingdom smile’, and one of them let it slip that they weren’t coping. every one of us had been feeling the same way and were too afraid to admit it. it was just such a revelation, we were all able to go ‘‘so it’s not just me!’’ and we were all able to finally see that we weren’t alone in finding it as difficult as what we were finding it. (sue) i am sure i often did what was so out of kilter with my own character because it was so important to be accepted and to be approved. you were living under this double bind all the time. (mark)  the phrase ‘‘double bind’’ is a valuable window into the experience of spiritual abuse. on the one hand, the member wants to please god and the leadership who represent god. however, to accomplish this requires the individual to stifle normal human nuances such as asking questions, expression of individual personality and the desire for comfort when in pain. this came at a cost as the following theme explains:  manifestation of internal states each of the participants recounted the physical and psychological repercussions of the previous five themes. for all of them there was a mix of physiological difficulties that they experienced as a result of the constant ‘‘double bind’’ they found themselves in: i was sick. i was sick all the time! my health . . . i was in and out of hospital. i had major surgery and i have a lot of major surgery. i have not been healthy, i was never healthy as a member. (sue) interviewer: megan, can you tell me a little bit about what might be the tension between, as you said before, your ‘independent thinking’ and you explaining you obeyed some of these directives. how did you hold those two in tension? megan: (laughing) okay. that is a really interesting question isn’t it? i suppose it came out in my in stress and it came out in anger . . . it also came out for me physically. i developed gall  
  908  d.j. ward  stones . . . i developed biliary colic of the liver and i developed an inflamed oesophagus and oesophageal erosion where the gastric fluids would erode my oesophageal lining and so when that all came to a head in that particular fashion where i had chronic indigestion, and it manifested because i was not allowed to [express individuality] and they could not mix.  as a consequence of the physical conditions, most of the participants sought out an external medical practitioner initially to get help. while seeking help outside the group was discouraged, the physical and emotional exhaustion was sufficient to chance any reprimand from the leadership.  discussion the following section explores the six themes in more depth followed by a conceptual map of the experience. firstly, it appears from the participants’ narratives, the theme leadership representing god acted as the cornerstone for the other themes. this theme was the driving force behind the others due to the fact that it was this aspect that provided the impetus for the others. in other words, much of their experiences noted in later themes would not have been tolerated were it not for the fact that during group membership, the individual perceives the authority of the leadership as binding. the leadership are seen as more pure, more spiritual and subsequently more authoritative. this creates tremendous symbolic power (sankowsky, 1995). each of the participants recalled how the treatment they received from the leadership was not unlike that of a chastening parent. he or she consequently tried harder to appease the leadership, only to become more dependent on them. two participants described this process as ‘‘forced immaturity’’ and ‘‘regression.’’ this negation of the self-worth of the member resembled that of a punitive parent-child relationship; the spirituality that initially was perceived by the individual as benign and deserving of obedience, is now eventually seen as ‘‘counterfeit’’ (welwood, 1983). this raises the oft-asked question about what constitutes sound spiritual authority and how to discern spiritual authority that could lend itself to the aforementioned abuses. as explained above, the theme of the leadership representing god was the foundation for the other interlocking themes, and the representation of the divine plus little or no accountability offers a fertile field for unchecked indulgences. of course, not all spiritual leadership is toxic. lewandowski and canda (1995) point out that a range of religious groups may well have controlling elements, but are balanced with other facets of group life such as open communication, clear and explicit expectations and freedom to express personal concerns. i suggest that it is the narcissistic elements in leadership that provide the primary impetus for any coercive manipulation coupled with little accountability. healthy spiritual leadership respects individual autonomy, tolerates and encourages critical thinking, and is appreciative of any power inequality. this is in contrast to leadership that is essentially self-serving. kets de vries and miller (1985) argue that narcissism occurs on a continuum. when it’s pathological, it echoes closely with the participants’ experiences of leadership: . . . narcissists become preoccupied with establishing their adequacy, power, beauty, status, prestige and superiority. at the same time, narcissists expect others to accept the high esteem in which they hold themselves, and to cater to their needs. what is striking in the behaviour of these people is their interpersonal exploitativeness. narcissists live under the illusion that they are entitled to be served, that their own wishes take precedence over those of others. they think that they deserve special consideration in life (p. 588).  
  mental health, religion & culture healthy spiritual leadership  909  toxic spiritual leadership  leadership recognises, and is sensitive to, power awareness of power issues, but dismissed due to issues.  narcissistic rewards through symbolic authority.  leadership accepts the individual due to  acceptance by leadership dependent upon  intrinsic human worth.  performance.  seeks to incorporate a healthy  a spiritual lens takes priority to the detriment of  bio/psycho/spiritual integration.  the other facets of our humanity.  seeks to cooperatively address spiritual needs.  spiritual needs exploited to satisfy the narcissistic needs of the leadership.  encourages a spirituality that can be expressed  spirituality is narrowly built around the self-  uniquely by each member within the same  centred perspective of the leadership.  group.  leadership recognises and acknowledges their  leadership with poor self-awareness and self-  own personal flaws and limitations.  evaluation; the group becomes an extension of the leadership’s narcissistic ego.  figure 2. healthy spiritual leadership versus toxic spiritual leadership.  typically for many phenomena in the social and behavioural sciences, toxic spirituality lies on a continuum and at what point it ‘‘crosses the line’’ can be difficult to establish. nonetheless, tentative comparisons between healthy and unhealthy leadership can be suggested as in figure 2. the issue of unhealthy individual personality characteristics meshing with personality characteristics of the leadership is still unclear. burke (2006) suggests that dependent personality structures in the membership may have been pre-existing before group membership and the narcissistic or anti-social features of the leadership facilitate their emergence. conversely, the membership may have few pre-existing personality factors and it is the group milieu that creates any anxious dependency. it is beyond the data in this small study to speculate either way. two of the participants used the term spiritual bullying to describe a range of attitudes and behaviours by the leadership that had adverse effects. while not using the term specifically, each of the other participants described events that closely resembled ‘‘bullying’’ behaviour such as intimidation, rejection and emotional manipulation. a common fear in this regard was to threaten with separation from family; a behaviour common in toxic groups (whitsett & kent, 2003). paralleling work-place bullying, each of the participant recounted episodes of being ignored, ridiculed and exposed to excessive fault-finding (einarson, hoel, zapf, & cooper, 2003). each of the participants also explained that to be considered worthy or spiritual in their respective group, one must perform in accordance with group norms as set by  
  910  d.j. ward  the leadership. an acceptance via performance mindset permeated the group milieu. that is, value in the group was measured by productivity; meet the expectations of the leadership and one is considered spiritually satisfactory. for a variety of reasons (e.g. health issues) should the individual not meet the ever-changing yardstick of the leadership, one was paraded to the group as spiritually weak. in this environment, perfection equates with spirituality with the resultant drive to perform. the dynamics of divine authority (leadership representing god) coupled with a strong group consciousness, converge to create strong persuasion in the group member. for whatever reason (perceived weakness, personality factors etc), should these two processes not create the desired response in the individual, more coercive behaviours from the leadership emerge (bullying behaviours). as the previous excerpts show, ‘‘acts of omission’’ were also deeply painful; what i have termed spiritual neglect. they represent situations in the participants’ life while in the group where they themselves or other members experienced significant relational, medical or emotional distress. however, the difficulties experienced were not addressed by the leaders. indeed, the person concerned was usually castigated for displaying any signs of frailty and it was commonly viewed as spiritual weakness. the participants had initially viewed the leadership as having answers to any crisis at hand. being god’s representatives, they were seen to be the final authority on life matters – regardless of whether or not the leadership had any expertise in the particular area of concern. as the participants shared, there were episodes of serious issues that included domestic violence, medical conditions and marriage breakdown. the members were incredulous at the lack of care demonstrated by the leaders. as one recalled, ‘‘i just couldn’t believe that they did nothing.’’ this theme revealed a profound lack of compassion at its core. corollary with this deficiency in empathy was the tendency to blame the individual for his or her pain. the multiple layers of spiritual abuse can start to be appreciated under such ‘‘self-serving’’ leadership (harwood, 2003). the participants’ accounts indicate that the leaders by virtue of their higher spiritual standing cannot be seen to be imperfect beings. it appears that the group itself was an extension of the leadership via the efforts to enforce compliance. when any member of the group revealed any ‘‘flaws’’ they were distanced from the leadership and perceived as spiritually weak. punishment then ensured. another theme emerged in the study that revealed an expanding external/internal tension. during the early stages of group membership there was little incongruence between the individual’s inner world (personality, values) and outer world (demands of the milieu). consequently, there is little or no tension between member and leadership; the group member wants to please those whom he or she believes are placed there by divine choice. however, this changes over time. as the participants shared, a conflict develops between the demands of the collective and one’s individuality eventually creating friction between the individual and the leadership. the internal dissonance is fed via the previous mechanisms of spiritual bullying, a strong performance orientation and spiritual neglect. these in turn have their genesis and maintenance via the divine authority represented in the leadership. as the participants in this study explained, these powerful forces created much internal anxiety. this internal pressure eventually builds to the extent that it manifests in a range of physical ailments. the expanding external/internal tension also creates more psychological distance between the member and leadership. the coercive tactics by the leadership initially used to produce conformity eventually backfire. as one participant declared ‘‘ . . . i just said to myself ‘this isn’t of god’; if this is god, i don’t want anything to do with god.’’ another important finding in this research has been that ‘‘spiritual’’ abuse creates far more than existential crises; there were also significant manifestations of internal states.  
  mental health, religion & culture  911  the participants’ recalled how when their physical and psychological systems reached exhaustion levels, various physiological and emotional consequences resulted. that is, the psycho-spiritual pressure had accumulated over a period of time and the result was manifested in a variety of bodily and psychological complaints. interestingly, despite most of the respondents not experiencing physical abuse, the psychological pain from their time in the group remained long after they left and gives credit to the view that emotional abuse can sometimes be more distressing than physical abuse (o’leary, 1999). two of the participants used the phrase ‘‘breakdown’’ to describe this experience. other participants used similar language where they reported as having panic attacks, depression, and ‘‘ . . . the life draining out.’’ the imagery parallels burnout, which can include elements such as emotional exhaustion, loss of idealism, somatic complaints and disillusionment (schaufeli & buunk, 2003). figure 3 is a representation of the above six themes. as it suggests, during the initial stages of group membership, there is little dissonance between the person’s inner world and the demands of the outer world (i.e. group demands). the notions that the leadership represent the divine, that they are trustworthy and are seen to be benign pastoral figures, are all accepted at the beginning. however as time progresses, performance orientation, along with bullying and neglectful behaviours create an internal tension that manifests externally. this process continues until the experience is no longer tolerable and the member departs the group. in this study, one member chose not to engage in any further formal or informal religious connection (‘‘spiritual separation’’), while the other five eventually reconnected with various christian denominations (‘‘spiritual rebuilding’’).  initial acceptance of ‘leadership representing god’  passing of time  acceptance via performance  spiritual bullying  spiritual neglect  expanding internal/external tension  intensifying manifestation of internal states  dissonance between inner and outer worlds no longer bearable  depart group ‘spiritual rebuilding’  figure 3. a conceptual map of spiritual abuse.  ‘spiritual separation’  
  912  d.j. ward  several other facets also emerge from the above that help illuminate the phenomenon of spiritual abuse. firstly, spiritual abuse is multifaceted with significant breadth in the experience. each participant recounted a range of emotional, physical and existential responses while in their respective group. it was often difficult to make sense of an experience that concurrently involved physiological and cognitive difficulties along with emotional and spiritual confusion. their relationships with other group members, family and ones’ relationship with god were also impacted. few areas of an individual’s life remained untouched by the experience. secondly, spiritual abuse is multilayered. the events mentioned above were often experienced simultaneously by the participants. corollary to this is that the aforementioned six themes are closely linked, and where one starts and another finishes is sometimes difficult to distinguish. this study also suggests that spiritual abuse is both process and event. the dynamics previously described are also interdependent that created circular processes that tended to reinforce each theme. for instance, when the leadership displayed any coercive or ‘‘bullying’’ behaviours, the internal tension for the individual increased accordingly. should the group member display any weakness, more punitive discipline was the result. this created further frailty within the individual which in turn elevated any physiological difficulties. throughout this process, the individual concerned experienced specific castigatory acts by the leadership that could be easily recalled many years after the event. however, it is important to note that for the participants in this study, acts of omission were often just as emotionally painful as were the more explicit coercive acts. the lack of compassion or care for group members was often the catalyst for much internal questioning; omissions by the leadership that best be described as spiritual neglect. it is apparent from the respondent narratives that spiritual abuse is a phenomenon that contains a range of facets found in other forms of abuse where there are significant boundary violations – particularly the common experiences of domestic abuse and workplace bullying. abuse in the home usually involves restricting various freedoms, intimidation and emotional manipulation. similarly, workplace bullying parallels some of the experiences of the participants such as being ignored, shouted at, being threatened, excessive monitoring or fault-finding (einarson et al., 2003, pp. 195, 196). a narcissistic leadership as described by the participants can also be found in other group-based situations such as psychotherapy (horwitz, 2000). in each scenario, there is a strong double bind created by the dual processes of mistreatment by those in a more powerful position, and trying to keep one’s internal world intact. this was the experience of the respondents in this study. for example, sue at one point lamented: . . . if i didn’t live god’s way then my children would pay the price and they would die an early death, so there was a mixture of emotions going in there . . . it engulfed me.  the experience of this female participant encapsulates the painful internal process that is at the very heart of spiritual abuse: how can i live ‘‘god’s way’’ (which i must) when ‘‘god’s way’’ is itself a source of so much pain? finally, i suggest that spiritual abuse is a phenomenon in its own right. one could argue that given many of the negative aspects of the experience were psychological or physiological, it might be better framed as ‘‘psycho-spiritual’’ abuse or simply ‘‘cult’’ abuse. however, i would argue that by doing so would dilute the core spiritual dimension that these participants found themselves in. this is in keeping with dehan and levi’s study  
  mental health, religion & culture  913  (2009) of abused ultraorthodox jewish women: when the abuser uses the realm of the woman’s spiritual experiences and connectedness beyond the self to hurt her and when the main damage does not occur at the interpersonal level, but rather at the transcendental one, the focal dimension of the abuse is spiritual (p. 1302).  similarly, the negative interpersonal aspects that the participants in this study experienced were a direct result of the spiritual environment. again, it was primarily due to the resolute belief that the leadership were spiritual representatives and who therefore had to be obeyed, that the resultant difficulties were tolerated for so long.  conclusion the question that initially framed this study was ‘‘what is the lived experience of spiritual abuse?’’ given the narratives of the six respondents in this study, coupled with what the literature informs us about injurious groups and their processes, i suggest that: spiritual abuse is a misuse of power in a spiritual context whereby spiritual authority is distorted to the detriment of those under its leadership. it is a multifaceted and multilayered experience that includes acts of commission and omission, aimed at producing conformity. it is both process and event, influencing one’s inner and outer worlds and has the potential to affect the biological, psychological, social and spiritual domains of the individual.  the above was a deeply felt experience for the respondents and their recollections in this study portrayed a confused distress as they tried to make sense of what was happening to them. i argue that the mistreatment the respondents in this study experienced has the potential to be observed in any religiously based group if there are insufficient processes for the accountability of leadership. it also offers another perspective on inappropriate conduct from the leadership in groups that do not meet the sometimes rigid criteria for a religious cult. this could also be extended to one-on-one ‘‘cultic relationships’’ (ward, 2000). the study has its limitations. the sample is obviously small and one cannot generalise. nonetheless while the study is small, it is congruent with current knowledge regarding dissonance and restrictive groups in general (langone, 1993; singer, 1995). while a larger sample might reveal other themes that this study could not discern, the experiences of each ex-member were remarkably similar to each other, despite exiting different groups. it therefore offers a starting point from which to understand the personal experience of spiritual abuse. second, while five out of the six participants exited different groups, they all departed groups that had a christian-based core. this is acknowledged as a potential limitation as it could have been fruitful to interview those who had left non-christian-based spirituality. the limitation of self reports must also be acknowledged. there was the reliance on the participant’s ability to recall their experiences, sometimes many years after the event. the very act of sharing one’s story has the potential to change the story in terms of detail or emphasis. i therefore acknowledge kvale and brinkmann’s point (2009, p. 183) that the transcripts are co-authored by subject and interviewer. nonetheless, each participant was able to recall in particular detail the events of their experience and the six core themes outlined above were strikingly common throughout all the narratives. in conclusion, the above study has obtained a picture of the phenomenon of spiritual abuse. it has articulated a complex experience and has provided insight into some of the difficulties of remaining in, and exiting out of, controversial religious groups. it has  
  914  d.j. ward  documented the importance of viewing persons as composite beings and that no one aspect of their life can be disconnected from the whole. the study also demonstrated that spirituality is not always experienced positively. like many facets of life, one’s spiritual life can be manipulated by others. upon reflection, perhaps the experiences of the participants in this study support the notion that ‘‘where love is absent, power occupies the vacancy.’’  acknowledgements this study formed the basis for the author’s mphil thesis in the school of social work, university of queensland (ward, 2007). deepest appreciation to dr rose melville and associate professor judith murray, and the anonymous reviewer.  references amendros, c., carrobles, j.a., & rodiguez-carballeira, a. (2007). former member’s perceptions of cult involvement. cultic studies review, 6, 1–19. asser, s.m., & swan, r. (2004). child fatalities from religion-motivated medical neglect. paediatrics, 101, 624–629. bland, m.j. (2001). the psychological and spiritual effects of child sexual abuse when the perpetrator is a catholic priest. dissertation abstracts international, a 63/04. bohm, j., & alison, l. (2001). an exploratory study in methods of distinguishing destructive cults. psychology, crime & law, 7, 133–165. bramley, n., & eatough, v. (2005). the experience of living with parkinson’s disease: an interpretative phenomenological analysis case study. psychology and health, 20, 223–235. burke, j. (2006). antisocial personality disorder in cult leaders and induction of dependent personality disorder in cult members. cultic studies review, 5, 390–410. buxant, c., saroglou, v., casalfiore, s., & christians, l. (2007). cognitive and emotional characteristics of new religious movements members: new questions and data on the mental health issue. mental health, religion & culture, 10, 219–238. dehan, n., & levi, z. (2009). spiritual abuse: an additional dimension of abuse experienced by abused haredi (ultraorthodox) jewish wives. violence against women, 15, 1294–1310. einarson, s., hoel, h., zapf, d., & cooper, c.l. (eds.) (2003). bullying and emotional abuse in the workplace. london: taylor & francis. emmons, r.a., & paloutzin, r.f. (2003). the psychology of religion. annual review of psychology, 54, 377–402. follinstad, d.r., & dehart, d.d. (2000). defining psychological abuse of husbands toward wives. journal of interpersonal violence, 15, 891–920. hansen, j.t. (2005). the devaluation of inner subjective experience by the counseling profession: a plea to reclaim the essence of the profession. journal of counseling and development, 80, 406–415. harwood, i. (2003). distinguishing between the facilitating and the self-serving charismatic group leader. group, 27, 121–129. hassan, s. (1988). combatting cult mind control. rochester, vt: park street press. haugaard, j.j. (2000). the challenge of defining child sexual abuse. american psychologist, 55, 1036–1039. horwitz, l. (2000). narcissistic leadership in psychotherapy groups. international journal of group psychotherapy, 50, 219–235. johnson, d., & vanvonderen, j. (1991). the subtle power of spiritual abuse. minneapolis, mn: bethany house. kets de vries, m.f.r., & miller, d. (1985). narcissism and leadership: an object relations perspective. human relations, 38, 583–601.  
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       child development, september/october 2006, volume 77, number 5, pages 1170 – 1189  perceived discrimination and the adjustment of african american youths: a five-year longitudinal analysis with contextual moderation effects gene h. brody, yi-fu chen, and velma mcbride murry  xiaojia ge university of california, davis  university of georgia  ronald l. simons university of georgia  frederick x. gibbons, meg gerrard, and carolyn e. cutrona iowa state university  longitudinal links between perceived racial discrimination and later conduct problems and depressive symptoms were examined among 714 african american adolescents who were 10 – 12 years old at recruitment. data were gathered 3 times over a 5-year period. hypotheses were tested via latent curve modeling and multiple-group latent growth modeling. increases in perceived discrimination were associated with increased conduct problems and depressive symptoms. this association was weaker when youths received nurturantinvolved parenting, affiliated with prosocial friends, and performed well academically. for conduct problems, the association was stronger for boys than for girls; for depressive symptoms, no gender differences emerged. the findings thus identify contextual variables that moderate the contribution of perceived discrimination to african american youths’ adjustment.  for some young people, internalizing symptoms (fleming & offord, 1990; lewinsohn, hops, roberts, seely, & andrews, 1993) and some forms of externalizing or conduct problem behaviors (see moffitt, 1993) increase significantly in prevalence and incidence during late childhood and early adolescence. this contributes to a nonnormative developmental trajectory that includes peer rejection (coie & dodge, 1998), a lack of motivation, poor academic performance (bergman & magnusson, 1997), and risk of school dropout (cairns, cairns, & neckerman, 1989; ensminger & slusarcick, 1992). it also forecasts alcohol misuse during late adolescence (brook & newcomb, 1995) and underemployment during young adulthood (sanford et al., 1994). the processes that contribute to the development of internalizing symptoms and conduct problems dur-  gene h. brody and velma mcbride murry, department of child and family development and center for family research. yi-fu chen, center for family research. xiaojio ge, department of human and community development. ronald l. simons, department of sociology. frederick x. gibbons, meg gerrard, and carolyn cutrona, department of psychology. this research was supported by grants from the national institute of mental health and the national institute on alcohol abuse and alcoholism. correspondence concerning this article should be addressed to gene h. brody, center for family research, university of georgia, 1095 college station road, athens, ga 30602-4527. electronic mail may be sent to gbrody@uga.edu.  ing this developmental period should be identified, not only to advance knowledge of their etiology and the trajectories they foster but also to inform the design of preventive interventions (see brody et al., 2004). using a three-wave prospective research design that spanned 5 years, we advanced and evaluated predictions about a salient vulnerability factor for african american youths, perceptions of racial discrimination. we also investigated predictions about moderation effects in the association of discrimination with the development of conduct problems and depressive symptoms, proposing that nurturantinvolved parenting, affiliation with prosocial peers, and school efficacy (including both academic success and commitment) would reduce the likelihood that african american youths who reported experiences with racial discrimination during late childhood and early adolescence would develop conduct problems or depressive symptoms. in the following sections, we first discuss racial discrimination and youth mental health, a central relationship around which the study is organized. we then describe the theoretical and empirical bases for the proposed moderational processes.  r 2006 by the society for research in child development, inc. all rights reserved. 0009-3920/2006/7705-0005  
  discrimination and youth adjustment  perceived discrimination and mental health outcomes racial discrimination presents daily challenges in the lives of african american youths and their families. landrine and klonoff (1996) found that 98% of the african american adults in their sample reported that they had experienced a racist event during the past year. all participants reported that, at some point in their lives, they had been treated badly or their intentions were misinterpreted because of their race. these experiences are demeaning and degrading, inducing stress, frustration, depression, and anxiety (brown et al., 2000; williams, yu, jackson, & anderson, 1997). studies of african american (jackson, williams, & torres, 1997; sanders-thompson, 1996; williams et al., 1997), hispanic (amaro, russo, & johnson, 1987; salgado de snyder, 1987), and asian (noh, beiser, kaspar, hou, & rummens, 1999) adults show an association between exposure to racial discrimination and depression. many of these studies are limited, however, by their reliance on a single item to index discrimination (kessler, mickelson, & williams, 1999). an association between racial discrimination and the development of adjustment problems among children and adolescents is also plausible. although a large majority of studies have focused on adults, researchers who work with minority children and adolescents (garci a coll et al., 1996) have recognized the powerful challenges that racial discrimination imposes on young people’s development. survey research with adolescents, which is consistent with this conjecture, corroborates the findings obtained with adults: assessments of perceived discrimination are associated with self-reported internalizing symptoms (fisher, wallace, & fenton, 2000; gibbons, gerrard, cleveland, wills, & brody, 2004; rumbaut, 1994; simons et al., 2002; szalacha et al., 2003; wong, eccles, & sameroff, 2003) and externalizing behaviors (dubois, braxton-burk, swenson, tevendale, & hardesty, 2002; simons, chen, stewart, & brody, 2003; szalacha et al., 2003). even worrying about the prospect of future racial discrimination places adolescents’ psychological well-being at risk (fordham & ogbu, 1986; mickelson, 1991; ogbu, 1978, 1991; taylor, wright, & porter, 1993). these findings resonate with franklin’s (1993) contention that ethnic minority individuals’ inner vigilance for racial slights can create a state of constant watchfulness that leads to chronic tension and stress. phinney, madden, and santos (1998) suggested that anxiety arising from this stress can increase adolescents’ likelihood of perceiving and reacting to discrimination. according to the theoretical rationale that un-  1171  derlies this study, however, perceived discrimination is more likely to contribute to emotional distress and conduct problems among youths rather than the reverse. to verify the validity of this rationale, our initial data analyses examined the relative strengths of the associations between perceived discrimination and youth psychological functioning over time. despite significant growth in the literature on racial discrimination and youth adjustment, many significant areas have yet to be explored. a fuller understanding of the contribution of discrimination to adjustment requires longitudinal analyses. such analyses enable scientists to examine the ways in which changes in african american youths’ experiences with discrimination during important developmental periods are linked to the course of their adjustment. most of the extant literature addresses the contemporaneous association between racial discrimination and youth adjustment. three studies, though, moved beyond this point to demonstrate relations between discrimination and adjustment during late childhood using two waves of data collected at intervals of 1 (wong et al., 2003) or 2 (gibbons et al., 2004; simons et al., 2003) years. the present study will extend the literature further; three waves of data collected over a 5-year period will be used to determine whether increases in youths’ perceptions of racial discrimination are associated with changes in their expression of conduct problems and depressive symptoms across early adolescence. as children make the transition into early adolescence, they begin to explore their ethnic identities (phinney & tarver, 1988). through this developmental process, youths come to understand the importance of their ethnic group membership to their thought processes, perceptions, feelings, and behavior (spencer & markstrom-adams, 1990). most african american youths develop positive ethnic identities and self-concepts despite negative messages they receive from the broader society about themselves and members of their ethnic group in general (spencer, fegley, & harpalani, 2003). the distress occasioned by assaults on african american youths’ developing identities from the demeaning messages inherent in discriminatory experiences, however, can exact a toll on their mental health (clark, anderson, clark, & williams, 1999). thoits (1991) maintained that those stressors that threaten the central parts of an individual’s identity are particularly pernicious and likely to undermine mental health. accordingly, african american youths’ experiences with discrimination over time have the potential to induce depressive symptoms such as  
  1172  brody et al.  sadness, fatigue, and irritability and to provoke problematic behaviors arising from anger and other negative emotions. thus, the first purpose of this study was to test the hypothesis that increases in perceived discrimination from late childhood through early adolescence will be linked to increases in conduct problems and depressive symptoms. both types of symptoms were assessed because links between vulnerability processes and mental health outcomes may be domain specific (luthar, doerberger, & zigler, 1993). the study also extends knowledge about the link between perceived discrimination and mental health outcomes among african american youths in two specific ways. first, the research was designed to determine whether longitudinal linkages between perceived discrimination and mental health outcomes are similar for boys and girls. it seems plausible that perceived discrimination’s link with depressive symptoms would be more pronounced for girls and its link with conduct problems would be more apparent for boys. this conjecture is based on data suggesting that females are likely to ruminate about and internalize negative feelings arising from relational and life stresses (nolen-hoeksema, 2004) whereas males are likely to become emotionally dysregulated and lose inhibitory controls (hetherington, 1989; rutter, 1990). second, we examined the association of socioeconomic status (ses) with african american youths’ exposure to perceived discrimination across time. in prior research, african american adults of higher ses reported more experiences with discrimination than did those of lower ses (gibbons et al., 2004; kessler et al., 1999; sigelman & welch, 1991). higher ses may render african americans more likely to have contact with individuals from other races, increasing their chances of exposure to racially discriminatory situations. thus, the analyses that address the first hypothesis will also test the generalizability of the hypothesized links across gender while determining whether increases across time in perceived discrimination vary as a function of youths’ ses. perceived discrimination, contextual processes, conduct problems, and depressive symptoms the second hypothesis stated that african american youths’ vulnerability to the development of conduct problems and depressive symptoms as a consequence of exposure to discriminatory experiences would be attenuated by nurturant-involved parenting, affiliation with prosocial peers, and school efficacy. we also tested the ancillary hypoth-  esis that increases over time in perceived discrimination would be positively associated with the development of conduct problems and depressive symptoms after controlling for parenting, peer affiliation, and school efficacy. the following sections present the theoretical bases and empirical support for these predictions. the theoretical rationale for the contextual processes’ mitigating effects is presented first; then, the parenting, peer, and school processes are considered in turn. the stress occasioned by repeated exposure to discrimination (clark et al., 1999) and the internalization of negative feedback about the self (allport, 1954; mead, 1934; rutter, 1988) are the mechanisms that underlie perceived discrimination’s link with conduct problems and depressive symptoms. the stress-coping model that has framed much of the research on the effects of discrimination (clark et al., 1999) posits that discriminatory experiences, like other stressful life experiences and daily hassles, deplete both adults’ and children’s coping resources. subsequent responses to the strains of demeaning discriminatory experiences take a variety of forms, ranging from anger and frustration to feelings of helplessness, sadness, and demoralization. clark et al. (1999) also proposed that the impact of discrimination on psychological functioning depends on contextual supports and the individual protective competencies they promote. thus far, cross-sectional studies have shown that parents’ racial socialization of their children and children’s competence in relating to people from different racial and ethnic groups mitigate discrimination’s negative effects (garci a coll et al., 1996; phinney et al., 1998; szalacha et al., 2003). we extended this line of research by examining the potential protective capacities of nurturant-involved parenting, affiliation with prosocial peers, and school efficacy. each of these contextual variables has been found to promote a positive, resilient sense of self as well as providing an ‘‘arena of comfort’’ when youth are confronted with stressors (luthar, 2006). recent reviews of the existing literature identify nurturant-involved parenting as one of the most robust predictors of resilient adaptation in children and adolescents (luthar & zelazo, 2003; masten, 2001; rutter, 2000; werner, 2000). for african american youths, nurturant-involved parenting that includes emotional support, instrumental assistance, and communication about potential areas of concern promotes a positive sense of self that enables youths to cope more effectively with both daily hassles and acute stressors (luthar, cicchetti, & becker, 2000). when combined with support and involvement,  
  discrimination and youth adjustment  high levels of parental vigilance and monitoring protect african american children from dangerous surroundings, hazardous experiences, and involvement in antisocial activity (brody et al., 2004; lamborn, dornbusch, & steinberg, 1996; simons et al., 2003) while decreasing their likelihood of developing depressive symptoms (brody et al., 2004; kim et al., 2003). this association has emerged for african american youths living in both nonmetropolitan (brody, dorsey, forehand, & armistead, 2002; brody, murry, kim, & brown, 2002; ge, brody, conger, simons, & murry, 2002; simons et al., 2003) and urban (bradley, rock, caldwell, harris, & hamrick, 1987; taylor & roberts, 1995) areas. decades of research have shown positive school experiences, including academic commitment and success, to be protective factors for youths’ adjustment and mental health outcomes (hawkins, catalano, & miller, 1992; petraitis, flay, & miller, 1995). when students are psychologically and behaviorally engaged in their schooling, their sense of academic efficacy, social efficacy, and prosocial orientations increase whereas antisocial orientations decrease (caprara, barbaranelli, pastorelli, bandura, & zimbardo, 2000). academic achievement and positive relationships with teachers help youths to foster mutually supportive intellectual relationships with like-minded peers through differential affiliation processes (elliott, huizinga, & ageton, 1985; jessor & jessor, 1977; patterson, debaryshe, & ramsey, 1989). these relationships, in turn, reduce the likelihood that youths will engage in antisocial behavior or develop depressive symptoms (caprara, et al., 2000; brody, kim, murry, & brown, 2005). for african american youths, academic success is also an objective accomplishment on which they can draw to counter the demeaning messages that discriminatory experiences include. to the extent that youths can attribute these messages to those who send them and not to their own characteristics, they will be unlikely to internalize the message to the detriment of their psychological adjustment (ruggiero & taylor, 1997). in addition to parenting and school experiences, peer relationships can serve important protective functions (bernard, 2004; jackson & warren, 2000). this is particularly true as young people make the transition from late childhood to early adolescence, when they increase the amount of time they spend with friends. various aspects of friendship quality have been found to be associated, both contemporaneously (armsden & greenberg, 1987; cauce, 1986; ryan, stiller, & lynch, 1994; way & chen, 2000) and longitudinally (buhrmester & yin, 1997), with high self-esteem and low levels of depressive  1173  symptoms. for children and adolescents who are at risk due to family difficulties or maltreatment, the protective benefits of positive peer relationships attenuate the impact of that risk on self-worth and social conduct (bolger, patterson, & kupersmidt, 1998; criss, petit, bates, dodge, & lapp, 2002; gauze, bukowski, aquan-assee, & sippola, 1996; lansford, criss, petit, dodge, & bates, 2003). we used a conceptualization of the protective function of peer relationships that differs from those used in previous studies. instead of examining relationship quality, we focused on the peers’ encouragement of academic achievement, involvement in after-school and community activities, and helpful behavior at home. to the extent that african american youths affiliate with friends who sanction and encourage such activities, the youths become more likely to engage in family and school experiences that are hypothesized to attenuate the effects of discrimination. as previously stated, a secondary purpose of the analyses was to determine whether perceived discrimination is linked to youth outcomes net of parenting, peer, and school processes. because these processes are linked, directly or indirectly, with youth conduct problems and depressive symptoms, they may confound any associations that may emerge between perceived discrimination and youth outcomes. researchers must demonstrate that the effects of perceived discrimination operate over and above those of other contextual processes. we dealt with this issue by using a latent growth curve model (lgc; mcardle & epstein, 1987; willett and sayer 1994) to examine the longitudinal links between perceived discrimination and the development of conduct problems and depressive symptoms. if the hypothesized links emerge, the model will be re-executed with links from the contextual processes added to the outcome measures. we predicted that increases in perceived discrimination over time would be related to african american youths’ development of conduct problems and depressive symptoms after controlling for the effects of parenting processes, affiliation with prosocial peers, and school efficacy. models tested figure 1 depicts the hypothetical model that addresses the effect of perceived discrimination throughout late childhood and early adolescence on the development of conduct problems and depressive symptoms. with this model, we examined the ways in which ses is related to perceived discrimination during late childhood (initial level of dis-  
  1174  brody et al.  ses  intercept for perceived discrimination  initial level of depression  slope for perceived discrimination  slope of depression  initial level of conduct problems  slope of conduct problems  figure 1. hypothetical model.  crimination) as well as changes in perceived discrimination throughout early adolescence (slope for perceived discrimination). we also used the model to determine whether slopes for perceived discrimination are related to those for conduct problems and depressive symptoms; these links are of greatest interest theoretically. a second model was tested to determine the extent to which the associations emerging in the original model would be reduced or eliminated with nurturant-involved parenting, peer prosociability, and school efficacy taken into account. the models were tested using three waves of data from the family and community health study (fachs). the first wave was collected when the youths were in late childhood; subsequent waves were collected approximately 2 and 5 years after the first data were collected. this data set enabled us to examine the hypotheses with data gathered throughout the youths’ early adolescence. method the fachs is a multisite study of contextual effects on health and development. it was designed to analyze the particular risks and resources that impede or facilitate african american family functioning and youth development in contexts other than inner cities. the sites that were sampled included rural, suburban, and metropolitan communities. data were collected in georgia and iowa using identical research procedures; the samples were combined after data analyses indicated that they were comparable on demographic, community, and  family process variables (cutrona, russell, hessling, brown, & murry, 2000). participants a total of 897 african american families, 475 in iowa and 422 in georgia, were recruited for participation in fachs. each family included a fifth-grade target youth who was 10 (52%), 11 (45%), or 12 (3%) years old at wave 1. slightly more than half (54%) were girls. of the 897 families, 779 (87%) remained in the sample at wave 2 and 767 (86%) were interviewed at wave 3. the analyses presented here include the 714 families for whom data from all three waves, collected in 1996, 1998, and 2001, were available. among these families, most (84%) of the target youths’ primary caregivers were their biological mothers, of whom 37% were married at wave 1. the rest were grandmothers (6%), biological fathers (5%), or other adults (5%). the caregivers’ mean age at wave 1 was 37 years, ranging from 23 to 80 years. at wave 1, the primary caregivers’ educational backgrounds ranged from less than a high school diploma (19%) to a bachelor’s or advanced degree (10%); the majority (71%) were high school graduates. their educational attainments changed little across the duration of the study. the mean family income across the three waves of data collection was  33,120; across the 5 years that separated the first and third waves, family income increased by an average of 12%. the families resided in a variety of settings, none of which could be characterized as a densely populated inner-city environment. on the basis of  
  discrimination and youth adjustment  criteria developed for the 2000 census (dalaker, 2001), the families’ residential settings were characterized as urban (n 5 120), suburban (n 5 563), or rural (n 5 101). sampling strategy, recruitment, and interview procedures families were recruited for fachs from multiple sites that varied considerably in demographic characteristics such as racial composition and economic level. potential participants were chosen randomly from lists of families with fifth-grade youths who lived in neighborhoods in which at least 10% of the population was african american. the lists were compiled by community liaisons in athens, georgia and by school officials in des moines and waterloo, iowa. each family received an introductory letter, followed by a recruitment phone call and a personal visit requesting the youth’s and caregiver’s participation in the study. the letter included a toll-free number through which families without home telephone service could contact the researchers. complete data were gathered from 72% of the families on the recruitment lists. most families who did not participate cited the amount of time the interviews would take as their reason for declining. (for further details about the fachs sample and the recruitment process, see brody et al., 2001; cutrona et al., 2000; gibbons et al., 2004; simons et al., 2002; wills, gibbons, gerrard, & brody, 2000.) in general, the sample was representative of the african american populations of the communities from which participants were recruited. to enhance rapport and cultural understanding, african american university students and community members served as field researchers to collect data from the families in their homes. before data collection, the researchers received 1 month of training in the administration of the self-report instruments. two home visits, each of which lasted 2 hr, were made to each family within 7 days as the families’ schedules allowed. during the first visit, informed consent was obtained; primary caregivers consented to their own and the youths’ participation and the youths agreed to participate. at each home visit, the self-report questionnaires were administered to the primary caregiver and the target youth in an interview format. each interview was conducted privately between one participant and one researcher, with no other family members present or able to overhear the interview. the instruments were presented on laptop computers. questions appeared in sequence on the computer screen, which both the researcher and the participant could see. the re-  1175  searcher read each question aloud and entered the participant’s response using the computer keypad. the second wave of data collection took place approximately 2 years after the first wave (m 5 25 months) and the third wave took place slightly more than 3 years after the second wave (m 5 38 months). caregivers received 100 and youths received 70 for their participation. measures perceived discrimination. at each wave of data collection, the target youths completed 13 items from a revised version of the schedule of racist events (sre; landrine & klonoff, 1996). the sre was designed for adult respondents; we revised it for youths in late childhood through adolescence. the revisions included simplifying the language and replacing items dealing with discrimination in the workplace with items about discriminatory behaviors in the community. the first step in the revision process involved presentation of the revised scale to focus groups of african american primary caregivers and youths of the same age as those in the study population; the second step included psychometric and validity analyses. in the first step, the revised scale was presented to four focus groups. two of the groups each included 10 african american primary caregivers with a child the age of the children targeted in this study; the other two groups each included 10 rural african american youths aged 10 – 12 years. the group members were asked to indicate whether the revised scale adequately covered the discriminatory events that children and adolescents would encounter in their communities and to suggest wording changes that would make the scale easy for youths to understand. all four focus groups reported that the revised scale effectively covered the discriminatory experiences that youths in their communities might experience. the analyses executed in the second step confirmed the scale’s reliability. its validity was demonstrated through its association with variables that the literature suggests would be associated with perceived discriminatory experiences, such as anger, a hostile world view, depression, and conduct problems (clark et al. 1999; landrine & klonoff, 1996), both in contemporaneous (simons et al., 2002) and 2-year longitudinal assessments (gibbons et al., 2004). these associations remained robust when family income, financial stress, negative life events, and parental education were controlled. the items in the revised sre assessed the frequency during the past year, ranging from 1 (never)  
  1176  brody et al.  to 4 (several times), with which the respondent perceived specific discriminatory behaviors. these events include racially based slurs and insults, disrespectful treatment from community members, physical threats, and false accusations from business employees or law enforcement officials. sample items include, ‘‘someone said something insulting to you because you are african american,’’ ‘‘a store owner or sales person working at a business treated you in a disrespectful way because you are african american,’’ ‘‘someone yelled a racial insult at you because you are african american,’’ and ‘‘you encountered whites who didn’t expect you to do well because you are african american.’’ coefficient alpha for the scale exceeded .85 at each wave of data collection. depression. at each wave, the target youths completed the diagnostic interview schedule for children – version 4 (disc – iv). the disc was developed over a 15-year period of research on thousands of children and parents; it has demonstrated reliability and validity (shaffer et al., 1993). version iv became available in 1995 and represents a modest revision, based on findings from the meca study (shaffer et al., 1993), of the disc – iii. the disc – iv generates both counts and diagnoses of symptoms; in the present study, only symptom counts were used because fewer than 5% of the youths in our sample met the criteria for clinical diagnoses. the symptoms that make up the 22-item major depression section include the frequency with which the respondent, during the previous year, felt sad, irritable, tired, restless, or worthless; slept more or less than usual; experienced difficulty in focusing or making decisions; or thought about death or suicide. alpha coefficients exceeded .83 for each wave of data collected. conduct problems. conduct problems were measured using the 21-item conduct disorder section of the disc – iv. target youths reported the frequency with which, during the previous year, they engaged in deviant acts such as shoplifting, physical assault, lying, fire setting, cruelty to animals, vandalism, burglary, and robbery. alpha coefficients were .69 for wave 1 data and .68 for data collected at waves 2 and 3. nurturant-involved parenting. primary caregivers and youths completed the nurturant-involved parenting scale (brody et al., 2001) at each wave of data collection. the scale is composed of summed standardized scores from scales that assess caregivers’ use of warmth, involvement, inductive reasoning, communication skills, and monitoring. each scale is rated on a 4-point response set that ranges from 1 (always) to 4 (never). the 9-item warmth/in-  volvement subscale concerns the extent to which caregivers provide emotional support to youths and spend time with them. the 9-item reasoning/communication subscale involves the degree to which caregivers express their views clearly, reason with the youths, and encourage them to consider the consequences of their behavior. the 4-item monitoring subscale deals with the caregivers’ level of awareness of the youths’ behavior in various settings. this scale has been used in previous studies with this sample (brody et al., 2001; ge et al., 2002). cronbach’s as for both primary caregivers’ and targets’ responses to the nurturant-involved parenting scale exceeded .80 at each wave of data collection. a multi-informant measure of nurturant-involved parenting was formed by adding the primary caregiver’s and youth’s reports at each wave, then summing those scores across the three waves of data collection. at each wave, correlations between the primary caregiver and youth reports exceeded .20, po.01. cronbach’s as for the full 22-item scale were .83 at wave 1, .88 at wave 2, and .91 at wave 3. school efficacy. a confirmatory factor analysis was conducted on 15 items developed for the iowa youth and families project (simons et al., 2003). these items loaded onto a single factor, which was termed school efficacy. at each data collection wave, caregivers rated the youths’ academic performance, ranging from 1 (superior) to 4 (far below average), as well as the youths’ valuation of academic efficacy and their relationships with their teachers, both rated 1 (strongly disagree) to 4 (strongly agree). items were coded so that high scores indicated positive outcomes: good grades, emphasis on good academic performance, and positive studentfteacher relationships. cronbach’s a exceeded .80 at each wave of data collection. prosocial peers. at waves 1 and 2, youths responded to a 9-item index, developed for this study, of the extent to which their friends encouraged involvement in prosocial activities. the youths used a 3-option response set, 1 (tell you to stop), 2 (do nothing), and 3 (encourage you to do it again), to indicate their friends’ likely reactions to their engagement in activities such as working hard for good grades, taking part in school activities, helping with chores at home, taking care of younger siblings, and taking part in community activities. responses to the items were summed to yield a total score measuring friends’ support of prosocial behavior. alpha coefficients for this scale were .79 at wave 1 and .82 at wave 2. ses. ses was assessed at each wave using the family’s annual income and an index of the primary caregiver’s educational level. the annual income  
  discrimination and youth adjustment  1177  table 1 descriptive statistics and correlations for study variables variable  1  2  3  4  5  6  7  8  9  10  11  12  13  1. family ses 2. nurturant-involved parentinga 3. school efficacya 4. prosocial peersb 5. perceived discrimination, wave 1 6. perceived discrimination, wave 2 7. perceived discrimination, wave 3 8. depression, wave 1 9. depression, wave 2 10. depression, wave 3 11. conduct problem, wave 1 12. conduct problem, wave 2 13. conduct problem, wave 3 m sd  f 0.06 0.13 0.01 0.09 0.01 0.10 0.03 0.00 0.10 0.07 0.02 0.05 0.01 1.67  f 0.22 0.26 0.06 0.01 0.02 0.12 0.11 0.07 0.17 0.25 0.22 319.00 66.00  f 0.08 0.10 0.04 0.05 0.12 0.06 0.06 0.15 0.22 0.18 20.60 5.76  f 0.10 0.01 0.01 0.02 0.01 0.01 0.14 0.20 0.12 44.70 9.50  f 0.49 0.30 0.25 0.29 0.14 0.29 0.22 0.15 21.28 7.04  f 0.48 0.22 0.29 0.13 0.17 0.28 0.19 21.06 7.13  f 0.23 0.19 0.17 0.17 0.16 0.23 22.47 7.47  f 0.32 0.21 0.26 0.19 0.15 5.63 4.61  f 0.34 0.15 0.32 0.19 6.39 4.48  f 0.05 0.09 0.31 5.68 4.79  f 0.32 0.26 .53 1.15  f 0.39 1.07 1.59  f 1.27 1.77  note. ses 5 socioeconomic status. all coefficients with an absolute value of .09 or higher are significant at po.05. a aggregated across 3 waves. b aggregated across 2 waves.  measure was derived from primary caregivers’ reports of income derived from employment, business ventures, government assistance, and child support. the education index ranged from 1 (less than a high school diploma) to 10 (a graduate degree). the income and education items were standardized and combined at each wave, and then aggregated across time by summing the measure across the three waves of data collection. cronbach’s a for this measure was .73. results attrition analyses to test for differences among families who provided data at various waves, we formed four groups: group 1 (n 5 65), wave 1 only; group 2 (n 5 65), waves 1 and 2; group 3 (n 5 53), waves 1 and 3; and group 4 (n 5 714), all three waves. univariate analyses of variance (anovas) conducted on each measure in the following analyses detected no intergroup differences. descriptive statistics table 1 presents the correlations, means, and standard deviations for the study variables. the majority of youths reported experiencing racial discrimination at some point during the study. by wave 3, only 8% of the youths, 10% of the boys and 6% of the girls, reported that they had not experienced any instances of racial discrimination. at wave 3, more  than half of the youths in the sample reported that someone had insulted them because they were african american and that family members or friends had been treated unfairly for the same reason. more than a quarter reported being excluded from an activity because of their race and more than half had encountered surprise from white people in response to their competent academic behavior. as the data in table 1 indicate, the youths’ rates of conduct problems were low throughout the study. consistent with findings from previous studies (elliott, huizinga, & menard, 1989), however, problem behaviors increased from late childhood to adolescence. at wave 1, 64% of the boys and 75% of the girls reported that they had not engaged in any problem behaviors during the past year; at wave 3, these percentages had dropped to 41% for boys and 46% for girls. most of the behaviors involved breaking curfews, lying, skipping school, and receiving in-school suspension. very few youths reported serious behaviors such as fighting, shoplifting, or committing infractions that involved the police. although at wave 3 only 4% of the youths met the disc – iv criteria for a diagnosis of clinical depression, 25% of the boys and 35% of the girls reported that they had experienced at least five depressive symptoms during the previous year. of the entire sample, the symptoms that youths most frequently reported were irritability (20% boys, 45% girls), loss of appetite (25% boys, 44% girls), sleeping more (35%  
  1178  brody et al.  perceived discrimination t1  perceived discrimination t2  .40*  .26*  .17* .50* .28* problem behaviors t1  problem behaviors t2  .34*  .52  .59  .54  .58  depression  conduct problems  depression  conduct problems  figure 2. cross-lag analysis for perceived discrimination, depression, and conduct problems.  boys, 41% girls) or less (25% boys, 36% girls) than usual, and difficulty concentrating (34% boys, 38% girls). discrimination and youth outcomes the theoretical rationale for this study is based on the premise that perceptions of racial discrimination lead to conduct problems and emotional distress among youths rather than the reverse. to justify this rationale, we conducted a cross-lag analysis using the first two waves of data. structural equation modeling (sem) was conducted in which the crosslags (e.g., wave 1 discrimination to wave 2 youth outcomes and wave 1 youth outcomes to wave 2 discrimination) were first constrained to be equal; the constrained model was then compared with one in which the two paths were free to vary. the nonconstrained model, pictured in figure 2, fit the data well, w2(3) 5 2.44, ns; cfi 5 1.00. the root mean square error of approximation (rmsea) was .00; 90% confidence interval (ci) 5 .00; .05. a significant reduction in chi-square from the constrained to the nonconstrained model indicates that one cross-lag is stronger than the other. in this case, both cross-lags were significant, but the path from perceived discrimination to youth outcomes was stronger than the path from youth outcomes to perceived discrimination. chi-square was reduced significantly, from 9.05 (df 5 4) to 2.44 (df 5 3), a change of 6.61 (df 5 1; po.01). plan of analysis for the study hypotheses latent growth curve modeling (lgm; singer & willett, 2003) was used to test the study hypotheses. previous studies of the links between perceived  discrimination and youth outcomes have included data collected at one or two time points. a youth’s rank order regarding perceived discrimination was compared with his or her rank order on the outcomes of interest at the same time or at a later time. such autoregressive procedures examine change over time by using residual change scores obtained by calculating the extent to which scores at one particular point in time differ from scores at a subsequent point in time. thus, change is assessed relative to predicted scores. when three waves of data are available, lgc modeling uses these data points to determine a change in constructs within individuals, and then allows an examination of the predictors of differences among individuals in their rates of change. applied to this study, lgc fits an ordinary least squares (ols) regression line to the three data points for perceived discrimination, conduct problems, and depressive symptoms for each youth. the regression lines describe the growth or change in each construct for each youth over the course of the study. the intercept for each youth represents his or her level of each construct at wave 1. the slope of each line indicates the rate at which each construct changes across the three waves of data collection. this allows for a determination of the initial level of each construct and changes in each construct over time that are based on youths’ actual data, and not on residual scores obtained at different points in time. lgc calculates the mean and variance for the intercepts of the study constructs (values at wave 1) as well as the mean and intercept for the slopes. lgc modeling treats the constructs’ intercepts and slopes as latent variables. the latent variable representing the initial level is defined by measurements at wave 1. factor loadings for all the indicators for the initial  
  discrimination and youth adjustment  level are fixed to 1. the latent construct corresponding to change varies depending on the mathematical form being tested (e.g., linear, quadratic, and so forth). in this study, we used a linear model. testing the study hypotheses involved several steps. first, univariate growth curve analyses were executed to test the measurement model for the latent growth constructs (perceived discrimination, conduct problems, and depressive symptoms). the lgc model presented in figure 1 was then evaluated to determine whether the hypothesized effectsfthat increases in individual trajectories of perceived discrimination would be linked to increases across 5 years in individual trajectories of conduct problems and depressive symptomsfwere statistically significant and to ensure that the hypothesized model would be consistent with the data. the lgc model was then estimated separately for boys and girls and multigroup comparisons were used to detect any gender differences in the longitudinal links among perceived discrimination, conduct problems, and depressive symptoms. finally, multigroup comparison procedures were used to test the hypothesis that significant associations between changes in perceived discrimination and changes in conduct problems and depressive symptoms would be less apparent for youths who received nurturant-involved parenting, evinced high levels of school efficacy, and associated with peers who encouraged involvement in prosocial activities. lgc modeling analyses linking discrimination to conduct problems and depressive symptoms we began by testing the measurement model for the latent growth constructs by fitting univariate growth curves for the variables of perceived dis-  1179  crimination, conduct problems, and depressive symptoms. the latent growth model comprises two constructs: one represents the intercept, or initial level, of these variables and the other represents their slope, or rate of change. the measurement model was based on reported levels of the variables at waves 1, 2, and 3. a test of the measurement model for the latent growth constructs was conducted, with the intercept construct specified by setting factor loadings for each of the reported levels of the three variables under consideration to 1. the slope construct was specified by setting the loadings to 0, 1, and 2, reflecting the approximately equal spacing of assessments over time. table 2 presents the intercept, intercept variance, slope, slope variance, and model fit indices for the univariate growth curve analyses. the linear growth curve for perceived discrimination across the three waves of data showed an acceptable fit: w2(1) 5 7.86, p 5 .000; cfi 5 .98; rmsea 5 .08 (ci 5 .02; .10). the mean initial sre score was 21.13 and the mean change across data collection waves was an increase of .30 per year. as the data in table 2 reveal, the variances for both the intercept and the slope were statistically significant, indicating significant variability around the means and variances for the intercept and slope constructs. the growth curve for conduct problems also showed an acceptable fit: w2(1) 5 14.00, p 5 .001; cfi 5 .93; rmsea 5 .10 (ci 5 .06; .12). the mean initial disc – iv conduct problems score was .60 and the mean change was an increase of .19 per year. again, the variances for both the intercept and slope were statistically significant (see table 2). the linear model for depression showed an adequate fit: w2(1) 5 19.30, p 5 .001; cfi 5 .88; rmsea 5 .11 (ci 5 .08; .13). the mean initial disc – iv depression score was 6.11 and the mean change was  table 2 univariate growth curve models intercept  variance of intercept  slope  variance of slope  model fit index  perceived discrimination  21.13  32.42  0.30  2.27  conduct problems  0.60  0.72  0.19  0.08  depression  6.11  8.85  0.06  0.60  w2 5 7.86, df 5 1, p 5 .005 cfi 5 0.98 rmsea 5 .08 (ci 5 .02; .10) w2 5 10.98 df 5 1, p 5 .001 cfi 5 0.95 rmsea 5 .10 (ci 5 .06; .12) w2 5 19.30, df 5 1, p 5 .001 cfi 5 0.88 rmsea 5 .11 (ci 5 .08; .13)  note. cfi 5 comparative fit index; rmsea 5 root mean square error of approximation.  po.01.  
  1180  brody et al.  ses .20*  .13*  .40* intercept for perceived discriminat ion  slope for perceived discriminat ion   .34*  .73*  .32*  .31* initial leve l of depression  slope of depression   .23  .03  .60* initial leve l of conduct problems  slope of conduct problems  .07  figure 3. latent growth curve test of the effect of perceived discrimination on depression and conduct problems.  .06. this slope coefficient was not statistically significant, suggesting that, on average, youths’ depression levels did not change across the 5 years of the study. the variances for both the intercept and slope, however, were statistically significant. this indicates substantial variability in the slope, in which the number of youths whose depressive symptoms increased was approximately equal to the number whose symptoms decreased. having fit univariate growth curves to the three longitudinal variables, the next step involved testing the multivariate model depicted in figure 1. this model examined the extent to which the initial level of perceived discrimination assessed at wave 1 and increases in perceived discrimination over time (slope of perceived discrimination) predicted the initial levels of conduct problems and depression assessed at wave 1 and their increases over time (slopes of conduct problems and depression). the results are presented in figure 3. the model showed an adequate fit to the data: w2(36) 5 153.63, po.01; cfi 5 .90; rmsea 5 .06 (ci 5 .05; .08). as expected, the wave 1 intercept for perceived discrimination was significantly correlated with those for conduct problems and depressive symptoms. this is consistent with past studies, reviewed previously, in which these associations emerged contemporaneously. the intercept for perceived discrimination was not significantly associated with the slope for conduct problems, but it was associated significantly and negatively with the slope for depressive symp-  toms. this suggests a ‘‘ceiling effect’’ in which youths who experience higher levels of discrimination during late childhood are less likely to develop additional depressive symptoms over time than those who initially experience less discrimination. as a check of this interpretation, an ols regression line was fitted to the three waves of data on depressive symptoms for youths who scored in the top and bottom thirds of the sample on the sre at wave 1. the regression line was steeper for youths reporting fewer depressive symptoms at wave 1, which is consistent with our interpretation. the analysis presented in figure 3 also tested the hypothesis that the slope for perceived discrimination would forecast the slopes for conduct problems and depressive symptoms. consistent with the hypothesis, increases in perceived discrimination from late childhood through early adolescence were linked with the development of conduct problems and depressive symptoms among african american youths. a measure of ses that was aggregated across the three waves was included as an exogenous control variable to determine whether the paths illustrated in figure 3 would change when links from ses were added to each parameter in the model. although the endogenous effects remained unchanged, ses was associated negatively with the intercept, but positively with the slope, for perceived discrimination. youths from higher-ses families reported lower levels of perceived discrimination at wave 1 and  
  discrimination and youth adjustment  greater increases in perceived discrimination from waves 1 to 3 than did youths from families of lower ses. these results suggest that a higher-ses family context may have protected youths from perceiving discrimination during late childhood, but with time the youths became more likely to perceive discriminatory situations. prior research has shown that, among african american adults, ses is positively associated with discriminatory experiences (kessler et al., 1999; williams & chung, in press). ours is the first longitudinal study that documents this association among african american youths. the paths from the slope for perceived discrimination to the slopes for conduct problems and depressive symptoms did not change with ses controlled; this suggests that the relation between discrimination and african american youths’ mental health is not an artifact of ses. a secondary purpose of this study was to determine whether perceived discrimination is linked to the development of youth outcomes after controlling for parenting processes, affiliation with prosocial peers, and school efficacy. because these processes have been shown to be linked, directly or indirectly, with youth conduct problems and depressive symptoms, they could confound the associations that emerged from the previous analysis. we predicted that increases in perceived discrimination over time would be positively related to african american youths’ development of conduct problems and depressive symptoms after controlling for the aforementioned variables. the model depicted in figure 2 was then re-executed with the time-varying parenting, prosocial peer, and school efficacy indicators added to the intercepts and slopes for the youth outcome variables. the model fit the data adequately: w2(42) 5 169.35, po.01; cfi 5 .90; rmsea 5 .07 (ci 5 .06; .09). the addition of these parameters did not change any of the results depicted in figure 3; the slope for perceived discrimination predicted the development of conduct problems and depressive symptoms even when nurturant-involved parenting, affiliation with prosocial peers, and school efficacy were controlled. gender differences. the model presented in figure 3 was rerun separately for boys and girls to determine whether gender differences would emerge in the results obtained for the full sample. the models fit the data well for both boys and girls: for boys, w2(31) 5 77.22, po.001, cfi 5 90, rmsea 5 .06 (ci 5 .04; .07); for girls, w2(27) 5 91.84, po.01, cfi 5 90, rmsea 5 .07 (ci 5 .05; .08). multigroup analyses using mplus 3.0 (muthe n & muthe n, 2004) were used to determine whether any of the specific  1181  paths depicted in figure 2 varied according to youth gender. a two-group invariance model was estimated by imposing equality constraints on every path coefficient. we then relaxed one path in the constrained model at a time and compared it with the constrained path via chi-square, df 5 1. this procedure was repeated for each path in the model, yielding independent comparisons in which the order of comparisons did not influence the test results. a change in chi-square between the constrained path and the relaxed path indicates a gender difference. the analyses revealed two paths for which chisquare was reduced significantly: the path from the slope for perceived discrimination to the slope for conduct problems, dw2(1) 5 7.88, po.05; and the path from the intercept for perceived discrimination to the intercept for conduct problems, dw2(1) 5 12.47, po.001. the association between the slopes for perceived discrimination and conduct problems was stronger for boys than for girls; standardized path coefficients were .55 for boys and .10 for girls. the association between the intercepts for perceived discrimination and conduct problems was also stronger for boys; standardized path coefficients were .73 for boys and .37 for girls. the link between perceived discrimination and depressive symptoms did not vary by gender. tests for moderation effects of parenting, school efficacy, and prosocial peers we hypothesized that african american youths’ vulnerability to the development of conduct problems and depressive symptoms as a consequence of perceived discrimination would be moderated by nurturant-involved parenting, affiliation with prosocial peers, and school efficacy. to test this hypothesis, multiple group analyses were conducted separately for each moderator. the sample was divided via median splits; for parenting and school efficacy, the median splits were derived from data aggregated across three waves, whereas the median split for affiliation with prosocial peers was based on two waves of aggregated data. a base model was determined through inputting covariance matrices and mean vectors for the subgroups and estimating the model in figure 3 simultaneously in both subgroups with no constraints (jaccard & wan, 1996; jo reskog & so rbom, 1996, see chapter 9; muthe n & muthe n, 2004; singer & willett 2003). we then imposed equality constraints to determine whether constraining the coefficients to be equal across the moderator subgroups would degrade the fit of the multiple group model as indicated by an increase in  
  1182  brody et al.  table 3 results of multigroup moderational analyses moderators  model  slope of discrimination to slope of depression nurturant-involved parenting equal across group free across group school efficacy  equal across group free across group  prosocial peers  equal across group free across group  initial level of discrimination to initial level of conduct problems nurturant-involved parenting equal across group free across group school efficacy  equal across group free across group  slope of discrimination to slope of conduct problems nurturant-involved parenting equal across group free across group school efficacy  equal across group free across group  prosocial peers  equal across group free across group  level  upc  dw2 (p)  low high low high low high low high low high low high  0.17 0.17 1.69 0.10 1.15 1.15 1.80 0.30 0.21 0.21 1.26 0.11  con: 204.63 df 5 59 base: 191.23 df 5 60 diff: 13.40 (.001)  low high low high low high low high  0.11 0.11 0.11 0.01 0.08 0.08 0.10 0.03  con: 207.72 df 5 59 base: 191.23 df 5 60 diff: 16.50 (.001)  low high low high low high low high low high low high  0.08 0.08 0.90 0.06 0.08 0.08 3.54 0.06 0.09 0.09 0.74 0.05  con: 204.11 df 5 59 base: 191.23 df 5 60 diff: 12.88 (.001)  con: 214.82 df 5 59 base: 202.38 df 5 60 diff: 12.44 (.001) con: 201.40 df 5 59 base: 187.96 df 5 60 diff: 13.43 (.001)  con: 211.16 df 5 59 base: 202.38 df 5 60 diff: 8.78 (.003)  con: 225.05 df 5 59 base: 202.38 df 5 60 diff: 22.68 (.001) con: 201.72 df 5 59 base: 187.96 df 5 60 diff: 13.75 (.001)  note. upc 5 unstandardized path coefficients; con 5 constrained model; base 5 unconstrained base model; diff 5 difference between constrained and base models.  chi-square over that of the base model with degrees of freedom equal to the number of parameters constrained. a significant difference in chi-square would indicate a moderation effect. table 3 presents the results of the multigroup analyses. to conserve space, only the associations for which multigroup differences emerged are included in the table. each of the hypothesized moderators produced a reduction in chi-square: for nurturantinvolved parenting, dw2(1) 5 12.88, po.01; for school efficacy, dw2(1) 5 22.68, po.01; for affiliation with prosocial peers, dw2(1) 5 13.75, po.01. these results indicate that the effect of perceived discrimina-  tion on the development of conduct problems was significantly weaker for youths in the high groups for nurturant-involved parenting, school efficacy, and affiliation with prosocial peers. when we allowed the path between the slope for perceived discrimination and the slope for depressive symptoms to vary across nurturant-involved parenting, affiliation with prosocial peers, and school efficacy, the model’s fit to the data improved further: dw2(1) 5 13.40, po.01; dw2(1) 5 13.43, po.01; and dw2(1) 5 12.44, po.01, respectively. the association between increases in perceived discrimination and the development of depressive symptoms was significantly  
  discrimination and youth adjustment  weaker among youths who received high levels of nurturant-involved parenting and whose friends encouraged involvement in prosocial activities. finally, the multigroup analysis also detected a significant reduction in chi-square and model fit improved when the path from the intercept for perceived discrimination to the intercept for conduct problems was allowed to vary. significant reductions in chi-square resulted for nurturant-involved parenting, dw2(1) 5 16.50, po.001, and school efficacy, dw2(1) 5 8.78, po.003. thus, the association of the intercepts for perceived discrimination and conduct problems at wave 1 was weaker for youths in the high nurturant-involved parenting and school efficacy groups. affiliation with prosocial peers did not moderate this link.  discussion using a longitudinal design, we tested an lgc model of the links from perceived discrimination to conduct problems and depressive symptoms among african american youths across late childhood and early adolescence. the results indicated that (a) increases across late childhood and early adolescence in perceived discrimination were linked positively with the development of conduct problems and depressive symptoms; (b) youths from higher-ses families were more likely to experience increases in perceived discrimination over time; (c) the link between the growth trajectories for perceived discrimination and conduct problems was stronger for boys than for girls, but no gender differences emerged for depressive symptoms; and (d) the impact of perceived discrimination on the outcome variables was reduced when youths received nurturant-involved parenting, had prosocial friends, and performed well in school. the basic growth model indicated that the intercepts and slopes for perceived discrimination were significantly related to those for the outcome variables across early adolescence; these effects were independent of socioeconomic characteristics. the analyses also indicated that the slope for perceived discrimination predicted conduct problems and depressive symptoms even with nurturant-involved parenting, affiliation with prosocial peers, and school efficacy controlled. these results are consistent with contemporaneous and short-term longitudinal studies, reviewed previously, in which variations in perceived discrimination were linked to variations in youths’ mental health. thus, as clark et al. (1999) proposed, effects derived from increases in  1183  perceived discrimination constitute an important contributor to african american youths’ adjustment. the findings from the lgc model raise questions about the risk mediation mechanisms through which perceived discrimination contributes to youth outcomes. simons et al. (2003) suggested an emotional mechanism in which anger and belief in the legitimacy of violence act as indirect links connecting perceived discrimination with conduct problems. both sociological (elliott et al., 1985) and psychological (patterson et al., 1989) theorists suggest that, after perceived discrimination elicits these attitudes, youths become likely to affiliate with peers who have similar outlooks. social selection effects such as these lead to social influence effects, which further influence conduct problems (menard & elliott, 1994; thornberry & krohn, 1997). the development of depressive symptoms could be related to similar mechanisms or to different ones (capaldi & patterson, 1991; ge et al., 1992). allport (1954) contended that one’s reputation, whether or not it is a correct representation of one’s actual characteristics, cannot be ‘‘hammered into one’s head without doing something to one’s character’’ (p. 142). this assertion suggests that those at the receiving end of discrimination can, over time, come to internalize the discriminators’ views. the psychological cost of striving to maintain a positive sense of self while facing frequent exposure to discriminatory experiences can tax youths’ coping resources, resulting in disillusionment, depression, and anxiety (brown et al., 2000; williams et al., 1997). understanding the risk mediation processes that connect perceived discrimination to youth outcomes is beyond the scope of this study. researchers interested in african american children’s and adolescents’ mental health, however, should focus on these dynamics. one of the primary purposes of this study was to determine whether parenting, peer, and school processes reduce the impact of perceived discrimination on african american youths’ adjustment. the results of multigroup analyses indicated that the longitudinal links of perceived discrimination with youth conduct problems were reduced among youths who received nurturant-involved parenting, had prosocial friends, or experienced high levels of school efficacy. these results extend findings from contemporaneous analyses, in which parental racial socialization processes reduced the effects of discrimination on african american children (garci a coll et al., 1996), by demonstrating with a longitudinal research design the importance of context in buffering african american youths from the vulnerability that discriminatory experiences induce.  
  1184  brody et al.  notably, these moderation effects were strong. one index of their effect size is the comparative magnitude of coefficients (jaccard & wan, 1996). in the multiple group models, the effect size shown by the coefficient between perceived discrimination and youth outcomes in the ‘‘low’’ protective context groups was two to three times as large as the coefficient in the ‘‘high’’ groups. the magnitude of these moderation effects is comparable to the impact of effective prevention programs (brody et al., 2004). the results of the moderational analyses are also pertinent to research on youth resilience, which indicates that some children who experience many discrete and chronic stressors do not succumb to their negative effects. similar to the youths in the present study, these children have supportive relationships with parents or extrafamilial adults who vigilantly monitor the children’s whereabouts and know their friends (brody et al., 2002; luthar, 2006; werner & smith, 1982; wyman, cowen, work, & parker, 1991). our findings are consistent with this literature and extend it by documenting the contributions that prosocial peer affiliations and school efficacy make to youths’ ability to resist the effects of perceived discrimination. the next step in this research process is to identify the ways in which the moderators in this study foster protection from discrimination. future researchers can explore several possible mechanisms, such as rejection of the negative messages about the self that discriminatory experiences contain; planful, self-regulated behavior; emotion regulation; non-anger-based coping strategies; and a future time orientation. we expect the parenting, peer, and school moderators to promote the development of these intraindividual processes, which in turn are hypothesized to minimize the effects of racial discrimination (see brody et al., 2005; murry et al., 2005). caution should be used, however, in extending the results of the moderation analyses to all african american youths. some youths who seem to be resilient may not be as adaptable as they appear; still others may be resilient in some areas but experience distress in other domains. research with children who have been maltreated (farber & egeland, 1987), whose mothers have depression (hammen, 2003), and whose parents have alcoholism (zucker, wong, puttler, & fitzgerald, 2003) support this caveat. even youths who are well-adjusted behaviorally and emotionally can have their resilient trajectories derailed by other vulnerabilities that perceived discrimination induces. we also investigated gender differences in the associations that we examined. although gender has  been identified as an important source of individual variability in stress and coping among members of ethnic minority groups (clark et al., 1999; slavin, rainer, mccreary, & gowda, 1991), few studies have examined gender differences in youths’ responses to discrimination. we expected the link between the slopes for perceived discrimination and conduct problems to be stronger for boys and the link between the slopes for perceived discrimination and depression to be stronger for girls. the results supported the gendered hypothesis for conduct problems but not for depressive symptoms. this finding may reflect beliefs that aggression is a more acceptable and effective coping tactic for boys than for girls. it is also consistent with other studies in which boys were found to be more likely than girls to respond to life stress by losing inhibitory controls and expressing anger and frustration through their behavior (hetherington, 1989; rutter, 1990). the lack of gender differences for the link between the slopes for perceived discrimination and depressive symptoms suggests that perceived discriminatory experiences, especially when they are perceived as rooted in unjust treatment, affect boys and girls similarly in this domain. prior research had not examined the function of ses in determining whether youths experience an increase in perceived discrimination across late childhood and early adolescence. building on research with african american adults, reviewed previously, we proposed that higher-ses youths would become more likely over time to interact with members of other racial groups, exposing them to more instances in which both overt and subtle instances of discrimination could take place. the positive association between ses and increases in perceived discrimination across early adolescence supports this hypothesis. these findings suggest that higher-ses african american youths may be more vulnerable to the negative effects of direct discriminatory experiences as a function of greater exposure to them, particularly if they are not prepared for such encounters (garci a coll et al., 1996; phinney et al., 1998). future research should be designed to detect ses differences in rates of exposure to multiple kinds of perceived discrimination, including vicarious exposure through demeaning and stereotypic portrayals of african americans in the media and perceived institutional discrimination that decreases access to competence-promoting school and community activities. future research should also identify the mechanisms through which neighborhood and community processes are linked with a greater probability that youths from higher ses households  
  discrimination and youth adjustment  will perceive discrimination. these youths may live in more extensively integrated neighborhoods and attend more extensively integrated schools; as a consequence, they may come into more frequent contact with white youths and adults in school and community contexts, which may increase their opportunities for perceiving racial discrimination (hamm, brown, & heck, 2005; szalacha et al., 2003). these hypotheses await empirical verification. assessments of perceived discrimination, conduct problems, and depressive symptoms were obtained from the youths at each wave of data collection. the decision to depend on youth reports for these constructs was based on the research literature and on our own longitudinal research program with rural african american families. analyses of primary caregivers’ assessments of target youths’ mental health outcomes in our previous studies revealed that caregivers reported a decrease or plateau in conduct problems and depressive symptoms as the youths made the transition from childhood to adolescence. the youths’ self-reports, however, did not correspond to this pattern; instead, they evinced increases in both conduct problems and depressive symptoms. we interpreted this discrepancy as underreporting of behavioral and emotional problems on the caregivers’ part as their children grew older. hartung, mccarthy, milich, and martin (2005) and lahey et al. (2000) obtained similar results and maintained that, as youths mature, they spend more time away from home, out of their parents’ presence; consequently, parents’ reports probably constitute accurate assessments of youths’ behavior at home, whereas youths’ reports encompass their behavior at home, in school, and in unstructured peer interactions. a second and related concern that common method variance could account for the findings obtained was addressed through the execution of a cross-lag analysis. this procedure demonstrated that perceived discrimination led to stronger changes in youth outcomes than vice versa, supporting our hypothesis. this result would not have emerged if common method variance among perceived discrimination, conduct problems, and depressive symptoms was responsible for the findings we obtained. most research on the effects of perceived discrimination and other contextual factors on the adjustment of african american youths has focused on those living in densely populated inner cities. african americans, however, grow up in diverse communities. the present study was conducted with african american families who resided in nonmetropolitan areas that were far less densely populated  1185  than urban settings. racial discrimination is as likely to operate in small or moderately sized communities as in large urban areas. regardless of population size or rural – urban location, when children and adolescents experience racial discrimination, challenges to their mental health increase. despite the strengths of the research design, limitations of this study and some caveats must be noted. first, models that include moderators other than those in the present model could also confer protective effects; racial socialization in particular should be included in future studies. second, the study did not focus on the risk mediation mechanisms that link perceived discrimination to youth adjustment outcomes. to advance understanding of these processes, future studies should incorporate measures that index youth-related variables such as chronic anger, beliefs about the legitimacy of aggression, self-efficacy, and differential peer affiliation processes. third, future studies should include a measure of attributional processes. if youths have tendencies to overperceive threat or bias, these tendencies could contribute both to misperceptions of racial discrimination and to conduct problems and depressive symptoms. fourth, because fewer than 5% of the participants displayed clinical levels of conduct problems or depressive symptoms, additional research is needed to determine the extent to which our findings can be generalized to youths who meet clinical criteria. these cautions notwithstanding, the present results add to the literature by documenting links from perceived discrimination to the development of conduct problems and depressive symptoms among african american youths throughout early adolescence. references allport, g. 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secondary_title_index: international journal of behavioral medicine
title_index: the brief resilience scale: assessing the ability to bounce back
abstract_index:
       while resilience has been defined as resistance to illness, adaptation,
  and thriving, the ability to bounce back or recover from stress is closest to its original
  meaning. previous resilience measures assess resources that may promote resilience
  rather than recovery, resistance, adaptation, or thriving. purpose: to test a new
  brief resilience scale. method: the brief resilience scale (brs) was created to assess
  the ability to bounce back or recover from stress. its psychometric characteristics
  were examined in four samples, including two student samples and samples with
  cardiac and chronic pain patients. results: the brs was reliable and measured as
  a unitary construct. it was predictably related to personal characteristics, social
  relations, coping, and health in all samples. it was negatively related to anxiety,
  depression, negative affect, and physical symptoms when other resilience measures
  and optimism, social support, and type d personality (high negative affect and
  high social inhibition) were controlled. there were large differences in brs scores
  between cardiac patients with and without type d and women with and without
  fibromyalgia. conclusion: the brs is a reliable means of assessing resilience as the
  ability to bounce back or recover from stress and may provide unique and important
  information about people coping with health-related stressors     

authors_index:
       smith, bruce w.     dalen, jeanne     wiggins, kathryn     tooley, erin     christopher, paulette     bernard, jennifer     

full_text_index:
       international journal of behavioral medicine, 15: 194–200, 2008 c taylor & francis group, llc copyright issn: 1070-5503 print / 1532-7558 online doi: 10.1080/10705500802222972  the brief resilience scale: assessing the ability to bounce back bruce w. smith, jeanne dalen, kathryn wiggins, erin tooley, paulette christopher, and jennifer bernard background: while resilience has been defined as resistance to illness, adaptation, and thriving, the ability to bounce back or recover from stress is closest to its original meaning. previous resilience measures assess resources that may promote resilience rather than recovery, resistance, adaptation, or thriving. purpose: to test a new brief resilience scale. method: the brief resilience scale (brs) was created to assess the ability to bounce back or recover from stress. its psychometric characteristics were examined in four samples, including two student samples and samples with cardiac and chronic pain patients. results: the brs was reliable and measured as a unitary construct. it was predictably related to personal characteristics, social relations, coping, and health in all samples. it was negatively related to anxiety, depression, negative affect, and physical symptoms when other resilience measures and optimism, social support, and type d personality (high negative affect and high social inhibition) were controlled. there were large differences in brs scores between cardiac patients with and without type d and women with and without fibromyalgia. conclusion: the brs is a reliable means of assessing resilience as the ability to bounce back or recover from stress and may provide unique and important information about people coping with health-related stressors. key words: brief resilience scale, stress, recovery, pain, cardiac resources that make them possible (ahern, kiehl, sole, & byers, 2006).  during the past decade, resilience has increasingly become a focus of research in the behavioral and medical sciences (charney, 2004; masten, 2001). however, “resilience” has been defined in a variety of ways, including the ability to bounce back or recover from stress, to adapt to stressful circumstances, to not become ill despite significant adversity, and to function above the norm in spite of stress or adversity (carver, 1998; tusaie & dyer, 2004). in addition, the measures that have been developed to assess “resilience” have not focused on these qualities but on the factors and  resilience as bouncing back the purpose of this article is to clarify the study of resilience by presenting a scale for assessing the original and most basic meaning of the word resilience. the root for the english word “resilience” is the word “resile,” which means “to bounce or spring back” (from re- “back” salire- “to jump, leap”; agnes, 2005). while recognizing that words evolve in meaning over time, the ability to bounce back or recover from stress may be important to assess and study in its own right. in addition, this ability may be particularly important for people who are already ill or are dealing with ongoing health-related stresses. in distinguishing between the other meanings associated with resilience, it may be useful to use different words for resistance to illness, adaptation to stress, and functioning above the norm in spite of stress. carver (1998) provided a clear distinction between “resilience” as returning to the previous level of functioning (e.g., bouncing back or recovery) and “thriving” as moving to a superior level of functioning following a stressful event. in addition, “adaptation” (or “stress adaptation”) could be used for changing to adjust to a new situation. finally, it may be preferable to use  all of the authors (bruce w. smith, jeanne dalen, kathy wiggins, erin tooley, paulette christopher, and jennifer bernard) are affiliated with the department of psychology, university of new mexico, albuquerque, new mexico. the authors gratefully acknowledge dr. richard d. lueker and the staff of new heart, inc., albuquerque, new mexico, for providing the opportunity to study patients in their cardiac rehabilitation program. we also gratefully acknowledge dr. paul mullins, dr. wilmer sibbitt, and erica montague for their help and support in the study of women with fibromyalgia and healthy controls. finally, we are grateful to the university of new mexico for providing a research allocation committee grant (#06-17) to support the study with women with fibromyalgia and healthy controls. correspondence concerning this article should be addressed to bruce w. smith, ph.d., department of psychology, university of new mexico, albuquerque, nm 87131-1161. e-mail: bwsmith@unm.edu  194  
  brief resilience scale  a word like “resistance” (as in “stress resistance” or “resistance to illness”) to refer to not becoming ill or showing a decrease in functioning during stress. previous measures of resilience even though several meanings have been associated with resilience, it is striking that measures of resilience have not directly targeted them. ahern et al. (2006) have recently reviewed the instruments that were designed to measure resilience. they focused on six measures, and the range of constructs measured included “protective factors that support resiliency,” “successful stress-coping ability,” “central protective resources of health adjustment,” “resilient coping behavior,” and “resilience as a positive personality characteristic that enhances individual adaptation” (p. 110). rather than specifically assessing resilience as the ability to bounce back, resist illness, adapt to stress, or thrive in the face of adversity, previous measures have generally assessed protective factors or resources that involve personal characteristics and coping styles. for example, the resilience scale (wagnild & young, 1993) aimed to assess equanimity, perseverance, self-reliance, meaningfulness, and existential aloneness. similarly, the connor davidson resilience scale (connor & davidson, 2003) aimed to assess characteristics such as self-efficacy, sense of humor, patience, optimism, and faith. in understanding people faced with health problems, it is undoubtedly important to identify the characteristics or factors that may promote resilience, such as optimism, active coping, and social support. while measures have been developed to assess these characteristics individually, the current “resilience” measures appear to provide a useful summary score of the resources that generally support positive adaptation. however, it may be more semantically accurate and clear to refer to characteristics that may increase the likelihood of resilience as “resilience resources.” the current studies the authors developed a brief resilience scale to determine whether it is possible to reliably assess resilience as bouncing back from stress, whether it is related to resilience resources, and whether it is related to important health outcomes. our strategy was to use as few items as necessary to develop a reliable scale for a unitary construct. we selected the final items from a list of potential items based on the feedback of research team members and piloting with undergraduate students. we included an equal number of positive and negatively worded items to reduce the effects of social desirability and positive response bias. we tested the brs on four separate samples to determine whether it is reliable and demonstrates convergent and predictive discriminate validity. we expected  that the ability to bounce back or recover from stress would be valuable in coping with health-related stressors. we included cardiac rehabilitation and chronic pain patients because resilience may be particularly important for them (chan, lai, & wong, 2006; zautra, johnson, & davis, 2005). our hypotheses were that the brs would represent one factor, would be related to resilience resources and health-related outcomes, and would predict health outcomes when controlling for resilience resources. methods participant samples the brs was tested on four samples. sample 1 consisted of 128 undergraduate students. sample 2 consisted of 64 undergraduate students. sample 3 consisted of 112 cardiac rehabilitation patients. sample 4 consisted of 50 women who either had fibromyalgia (n 20) or were healthy controls (n 30). all four samples were recruited from a mediumsized metropolitan area in the southwestern u.s. (albuquerque, new mexico). design the brs was administered to each of these four samples in questionnaires. the questionnaires for each sample were not identical but measured many of the same constructs. these questionnaires assessed a range of resilience-related constructs, other personal characteristics, coping styles, social relationships, and healthrelated outcomes. the list of measures below indicates which measures were included for each sample. the brief resilience scale the six items of the brief resilience scale (brs) are presented in table 1. items 1, 3, and 5 are positively worded, and items 2, 4, and 6 are negatively worded. the brs is scored by reverse coding items 2, 4, and 6 and finding the mean of the six items. the following instructions are used to administer the scale: “please indicate the extent to which you agree with each of the following statements by using the following scale: 1 strongly disagree, 2 disagree, 3 neutral, 4 agree, 5 strongly agree.” other measures 1. resilience-related constructs connor-davidson resilience scale (cd-risc; connor & davidson, 2003). the cd-risc was designed to assess the personal characteristics that embody resilience. it contains 25 items responded to 195  
  smith et al.  table 1.  the brief resilience scale: items and factor loadings  items 1. i tend to bounce back quickly after hard times 2. i have a hard time making it through stressful events (r) 3. it does not take me long to recover from a stressful event 4. it is hard for me to snap back when something bad happens (r) 5. i usually come through difficult times with little trouble 6. i tend to take a long time to get over set-backs in my life (r)  sample 1  sample 2  sample 3  sample 4  .77 .73 .78 .85 .69 .84  .79 .78 .78 .90 .69 .81  .70 .68 .71 .70 .71 .67  .89 .91 .71 .85 .68 .68  note. sample 1 128 undergraduate students; sample 2 64 undergraduate students; sample 3 112 cardiac rehabilitation patients; sample 4 50 women with fibromyalgia or healthy controls. r reverse coded items.  on a 5-point scale. the cd-risc was included in sample 1. ego resiliency scale (block & kremen, 1996). this was designed to assess “the ability to change from and also return to the individual’s characteristics level of ego-control after the temporary, accommodationrequiring, stressing influence is no longer acutely present” (block & kremen, 1996; p. 351). it contains 14 items responded to on a 4-point scale and was included in sample 1. 2. other personal characteristics life orientation test-revised (lot-r; scheier, carver, & bridges, 1994). the lot-r included three items assessing optimism and three items assessing pessimism. the items are responded to on a 5-point scale. the optimism items were in all samples and the pessimism items were in samples, 1, 2, and 4. purpose in life (ryff & keyes, 1995). this assesses the belief that one’s life has meaning and purpose. the items are scored on a 6-point scale. the 9-item version was in samples 1 and 4 and the 3-item version was in sample 3. toronto alexithymia scale (tas-20; bagby, parker, & taylor, 1994). the tas-20 was designed to assess difficulty finding words for feelings. the 20 items are scored on a 5-point scale and were included in samples 1 and 4. type d personality (ds14; denollet, 2005). the ds14 assesses for type d personality. type d is a joint tendency toward negative affectivity and social inhibition and has been related to poor cardiac prognosis (denollet, 2005). fourteen items are scored on a 5-point scale. seven items assess negative affectivity and seven items assess social inhibition. it was included in sample 3. 3. coping styles brief cope (carver, 1997). the brief cope consists of 28 items to assess 14 coping strategies. the items are scores on a 4-point scale. all of the items were included in samples 1 and 4, and items for selected strategies were included in samples 2 and 3. 196  4. social relationships interpersonal support evaluation list (isel; cohen, mermelstein, karmarck, & hoberman, 1985). the isel consists of 12 items to assess social support using a 4-point scale. it was included in samples 1 and 2. mos social support survey (mos-sss; sherbourne & stewart, 1991). this consists of 20 items assessing social support using a 5-point scale. an 8-item short version was in sample 3, and the full 20-item version was in sample 4. negative social interactions (finch, okun, barrera, zautra, & reich, 1989). this measure includes four items to assess negative social interactions. these items were included in samples 1, 2, and 4.  5. health-related outcomes brief health-related measures. sample 3 also included one 7-point item assessing the number of exercise days per week. samples 3 and 4 included a 10point item measuring fatigue. sample 4 included three visual analogue scales assessing current, worse, and average pain that were summed to form an overall index of pain. hospital anxiety and depression scale (hads; zigmond & snaith, 1983). there are 7 items each to assess anxiety and depression. the items are scored on a 4-point scale. the hads was included in samples 3 and 4. mental health inventory (veit & ware, 1983). this consists of 9 items to assess anxiety and 9 items to assess depression. the items are scored on 5- or 6-point scales. these items were included in samples 1 and 2. mood adjective checklist (larsen & diener, 1992). six items were included to assess negative affect and six items were included to assess positive affect. they were scored on a 6-point scale and were included in sample 3. physical symptoms index (moos, cronkite, & finney, 1986). this measure includes 12 items to assess physical symptoms such as headaches and constipation. it was included in samples 1, 3, and 4.  
  brief resilience scale  perceived stress scale (pss; cohen, kamarck, & mermelstein, 1983). the pss consists of 10 items that assess perceived stress. the items are scored on a 4point scale. the pss was included in all four samples. positive and negative affect schedule (panas; watson, clark, & tellegen, 1988). the panas includes 20 items to assess positive and negative affect. it was scored on a 5-point scale and included in samples 1, 2, and 4. statistical analyses the primary analyses assessed the factor structure, reliability, and validity of the brs. the factor structure was examined by principal components analyses (pca) with a varimax rotation retaining eigenvalues 1. internal consistency was examined using cronbach’s alpha, and test-retest reliability was examined using the intra-class correlation (icc) for absolute agreement. convergent validity was assessed by zero-order correlations between the brs and the other measures. discriminant predictive validity was assessed by partial correlations, with health-related outcomes controlling for other predictors. in addition, we compared mean brs scores across samples and subgroups using independent samples t-tests.  .80, .91, respectively). the brs was given twice in two samples with a test-retest reliability (icc) of .69 for one month in 48 participants from sample 2 and .62 for three months in 61 participants from sample 3. convergent validity table 3 shows the zero-order correlations between the brs and personal characteristics, social relations, coping, and health outcomes for each sample. the brs was positively correlated with the resilience measures, optimism, and purpose in life, and negatively correlated with pessimism and alexithymia. in addition, it was positively correlated with social support and negatively correlated with negative interactions. finally, it was consistently positively correlated with active coping and positive reframing and negatively correlated with behavioral disengagement, denial, and self-blame. with regard to health-related outcomes, the brs was consistently negatively correlated with perceived stress, anxiety, depression, negative affect, and physical symptoms. in addition, it was positively correlated with positive affect in three of the four samples and with exercise days per week in the cardiac rehabilitation sample. it was negatively correlated with fatigue in the cardiac sample and negatively correlated with fatigue and pain in the sample of middle-aged women.  results discriminant predictive validity table 2 displays the descriptive statistics for age, gender, and the brs for each sample. samples 1 and 2 were young and primarily female. sample 3 was relatively old and primarily male. sample 4 was middleaged and all female. the mean brs scores ranged from 3.53 in sample 1 to 3.98 in sample 3. brs scores were significantly higher in sample 3 than in samples 1, 2, and 4 combined (3.98 vs. 3.56, t 5.053, df 352, p .001), which did not differ from each other. factor structure and reliability table 1 shows the pca loadings of the brs items for each of the four samples. the results for each sample revealed a one-factor solution accounting for 55– 67% of the variance (samples 1–4 61%, 61%, 57%, 67%, respectively). the loadings ranged from .68 to .91. internal consistency was good, with cronbach’s alpha ranging from .80–.91(samples 1–4 .84, .87, table 2.  descriptive statistics for the four samples sample 1 sample 2 sample 3 sample 4  sample size 128 64 112 50 age (years) 20.4 (4.0) 19.8 (3.0) 62.8 (10.5) 47.3 (8.2) gender(% female) 76 67 24 100 brs scores 3.53 (0.68) 3.57 (0.76) 3.98 (0.68) 3.61 (0.85) note. standard deviations are listed in parentheses.  we examined discriminant predictive validity in the two larger samples. table 4 shows the zero-order and partial correlations between each of the brs, cdrisc, ego resiliency, and the health outcomes in the first undergraduate sample. the zero-order correlations revealed that the “resilience” measures were almost always related in the expected direction with the outcomes, with the exception that ego resiliency was only marginally related to less negative affect. the partial correlations were obtained by correlating each resilience measure with each outcome, while controlling for both of the other “resilience” measures. the brs was still negatively related to perceived stress, anxiety, depression, negative affect, and physical symptoms. the cd-risc was still negatively related to perceived stress and still positively related to positive affect. the ego resiliency scale was still positively related to positive affect. table 5 shows the zero-order and partial correlations between the brs, optimism, social support, and type d and the health outcomes in the cardiac sample. the zero-order correlations revealed that the brs was correlated with all seven outcomes and that optimism, social support, and type d were correlated with five outcomes. the partial correlations showed that the brs was still related to perceived stress, anxiety, depression, negative affect, fatigue, and marginally to exercise days. optimism was still related to perceived stress, 197  
  smith et al.  table 3. measure  correlations between the brief resilience scale and other  personal characteristics alexithymia cd-risc ego resiliency optimism pessimism purpose in life social relationships negative interactions social support coping acceptance active coping behavioral disengagement denial humor planning positive reframing religion self-blame self-distraction substance use using emotional support using instrumental support venting health-related outcomes anxiety depression exercise days fatigue negative affect pain perceived stress physical symptoms positive affect  sample 1  sample 2  sample 3  sample 4   .47 .59 .51 .45  .40 .46  — — — .63  .56 —  — — — .69 — .47   .44 — 49 .55  .32 .67   .25 .28   .47 .27  — .30   .46 .40  .43 .40  .39  .37 .32 .27 .40 .16  .27 .07  .06 .16 .15  .14  .42 .41 —  .33 .18 — .41 —  .47 —  .45 .10 .33 —  .18 .38 —  .32 .09 — .38 —  .36 —  .22 — — .04  .22 .31  .52  .53 .08 .42 .31 .08  .35  .26  .32 .13  .12 .16   .46  .41 — —  .34 —  .60  .39 .46   .56  .49 — —  .53 —  .71  .28 .17   .53  .50 .23  .32  .51 —  .61 — .45   .60  .66 —  .55  .68  .59  .64  .50 .63  note. sample 1 128 students; sample 2 64 students; sample 3 112 cardiac patients; sample 4 50 women with fibromyalgia or healthy controls. p .10, *p .05, **p .01.  anxiety, and positive affect, and marginally to negative affect. social support was still related to positive affect and marginally to anxiety. type d was still related to depression and negative affect and marginally to positive affect.  subgroup differences in brs scores finally, we wanted to determine whether there were subgroup differences in mean brs scores between men and women within samples, between participants with  table 4. zero-order and partial correlations between resilience measures and outcomes for undergraduate studentsa zero-order correlations  perceived stress anxiety depression negative affect positive affect physical symptoms  partial correlations  brs  cd-risc  ego resiliency  brs  cd-risc  ego resiliency  –.60** –.46** –.41** –.34** .46** –.39**  –.53** –.40** –.35** –.25** .68** –.35**  –.40** –.33** .28** –.16 .69** –.25*  –.38** –.29** –.21* –.24* .09 –.23*  –.26* –.15 –.14 –.14 .40** –.15  .04 –.02 –.04 .12 .26** .04  a sample 1 (128 undergraduates students). p .10, *p .05, **p .01.  198  
  brief resilience scale  table 5. zero-order and partial correlations of the brief resilience scale, optimism, social support, and type d for cardiac patientsa zero-order correlations  perceived stress anxiety depression negative affect positive affect fatigue exercise days  partial correlations  brs  optimism  social support  type d  brs  optimism  social support  type d   .61  .53  .50  .51 .45  .32 .23   .38  .34  .25  .39 .40  .18 .06   .29  .35  .26  .19 .25  .19 .11  .35 .36 .46 .43  .36 .13  .08   .46  .33  .37  .35 .20  .28 .19   .30  .24  .08  .22 .28  .07  .07   .12  .20  .17 .01 .23  .17  .06  .05 .01 .32 .20  .19 .00 .06  a sample 3 (112 cardiac rehabilitation patients). p .10, p .05, p .01.  type d and without type d in sample 3, and between women with and without fibromyalgia in sample 4. there were no differences between men and women in samples 1 and 2, but brs scores were higher in men (m 4.07, sd 0.66) than for women (m 3.67, sd 0.70) in sample 3 (t 2.673, df 110, p .01, d .60). gender differences could not be examined in sample 4 because it only included women. in sample 3, the brs scores were higher for the 93 cardiac patients without type d (m 4.11, sd 0.60) than for the 19 cardiac patients with type d (m 3.27, sd 0.67; t 5.318, df 110, p .001, d 1.32). finally, in sample 4, brs scores were higher for the 30 women without fibromyalgia (m 3.96, sd 0.58) than for the 20 women with fibromyalgia (m 3.09, sd 0.93; t 4.074, df 48, p .001; d 1.12). discussion the purpose of this study was to test a new brief resilience scale to assess the ability to bounce back or recover from stress. we examined the brs in two student and two behavioral medicine samples. we found that the brs demonstrated good internal consistency and test-retest reliability. in addition, our hypotheses that it would represent one factor, would be related to resilience resources and health-outcomes, and would predict health outcomes beyond resilience resources were supported. finally, there were brs score differences between those with and without type d and those with and without fibromyalgia. the results suggest that the brs may have a unique place in behavioral medicine research. first, previous measures of resilience target the personal characteristics that may promote positive adaptation and not resilience itself. the brs is the only measure that specifically assesses resilience in its original and most basic meaning: to bounce back or recover from stress (agnes, 2005). when studying people who are already ill, assessing the specific ability to recover may be more important than assessing the ability to resist illness.  second, the brs may be uniquely related to health when controlling for previous resilience measures and measures of individual resilience resources (e.g., optimism and social support). since the brs is framed with regard to negative events (“stressful events,” “hard times,” “difficult times,” “set-backs”), it is not surprising that its unique effects were specific to reducing negative outcomes (anxiety, depression, negative affect, physical symptoms). third, the relationship that we found between the brs and resilience resources suggests it may mediate the effects of resilience resources on health outcomes. resources such as optimism, social support, active coping, and the range of those assessed by previous resilience measures may facilitate the ability to recover from stress or adversity. the ability to recover itself may, in turn, have a more direct relationship with health outcomes. finally, these studies have limitations which lay the groundwork for future studies using the brs. the brs needs to be used in longitudinal studies to determine whether it predicts recovery from important health stressors. in addition, the brs needs to be compared with physiological indicators of bouncing back or recovery from stress and illness (charney, 2004). last, the relationship between the brs and other forms of positive adaptation, such as thriving and posttraumatic growth, and their effects on health needs to be examined. references agnes, m. (ed.). (2005). webster’s new college dictionary. cleveland, oh: wiley. ahern, n. r., kiehl, e. m., sole, m. l., & byers, j. (2006). a review of instruments measuring resilience. issues in comprehensive pediatric nursing, 29, 103–125. bagby, m. r., parker, j. d. a., & taylor, g. j. (1994). the twentyitem toronto alexithymia scale-i item selection and crossvalidation of the factor structure. journal of personality and social psychology, 38, 23–32. block, j., & kremen, a. m. (1996). iq and ego-resiliency: conceptual and empirical connections and separateness. journal of personality and social psychology, 70, 349–361.  199  
  smith et al. carver, c. s. (1997). you want to measure coping but your protocol’s too long: consider the brief cope. international journal of behavioral medicine, 4, 92–100. carver, c. s. (1998). resilience and thriving: issues, models, and linkages. journal of social issues, 54, 245–266. chan, i. w. s., lai, j. c. l., & wong, k. w. n. (2006). resilience is associated with better recovery in chinese people diagnosed with coronary heart disease. psychology and health, 21(3), 335–349. charney, d. s. (2004). psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. american journal of psychiatry, 161, 195–216. cohen, s., kamarck, t., & mermelstein, r. (1983). a global measure of perceived stress. journal of health and social behavior, 24, 385–396. cohen, s., mermelstein, r., karmarck, t., & hoberman, h. (1985). measuring the functional components of social support. in i. g. sarason & b. r. sarason (eds.), social support: theory, research, and application. the hague, holland: martinus nijhoff. connor, k. m., & davidson, j. r. t. (2003). development of a new resilience scale: the connor-davidson resilience scale (cd-risc). depression and anxiety, 18, 76–82. denollet, j. (2005). ds14: standard assessment of negative affectivity, social inhibition, and type d personality. psychosomatic medicine, 67, 89–97. finch, j. f., okun, m. a., barrera, m., zautra, a. j., & reich, j. w. (1989). positive and negative social ties among older adults: measurement models and the prediction of psychological stress and well-being. american journal of community psychology, 17, 585–605. larsen, r., & diener, e. (1992). promises and problems with the circumplex model of emotion. in m. s. clarke (ed.), emotion (pp. 25–59). newbury park, ca: sage.  200  masten, a. s. (2001). ordinary magic: resilience processes in development. american psychologist, 56, 227–238. moos, r. h., cronkite, r. c., & finney, j. w. (1986). health and daily living manual (2nd ed.). palo alto, ca: center for health care evaluation, stanford university medical centers. ryff, c. d., & keyes, c. l. m. (1995). the structure of psychological well-being revisited. journal of personality and social psychology, 69, 719–727. scheier, m. f., carver, c. s., & bridges, m. w. (1994). distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the life orientation test. journal of personality and social psychology, 67, 1063– 1078. sherbourne, c. d., & stewart, a. l. (1991). the mos social support survey. social science and medicine, 32, 705–714. tusaie, k., & dyer, j. (2004). resilience: a historical review of the construct. holistic nursing practice, 18, 3–8. veit, c. t., & ware, j. e. (1983). the structure of psychological distress and well-being in general populations. journal of consulting and clinical psychology, 51, 730–742. wagnild, g. m., & young, h. m. (1993). development and psychometric evaluation of the resilience scale. journal of nursing measurement, 1, 165–178. watson, d., clark, l. a., & tellegen, a. (1988). development and validation of brief measures of positive and negative affect: the panas scales. journal of personality and social psychology, 54, 1063–1070. zautra, a. j., johnson, l. m., & davis, m. c. (2005). positive affect as a source for resilience for women in chronic pain. journal of consulting and clinical psychology, 73, 212– 220. zigmond, a. s., & snaith, r. p. (1983). the hospital anxiety and depression scale. acta psychiatrica scandinavica, 67, 361– 370.     


authors_index: upenieks, laura ford-robertson, joanne
secondary_title_index: journal of religion and health
abstract_index:
       the “spiritual but not religious” (sbnr) are a growing group in the religious landscape of the united states. thousands of studies to date have been devoted to the study of religion and health, but far less attention has been given to the study of the “spiritual but not religious.” in this study, we address this gap by using two waves of longitudinal data from the national study of youth and religion (2005–2008). we assess whether within-person changes in sbnr identity are associated with health and mental health in emerging adulthood and consider several pathways that may account for observed differences. results suggest that consistently identifying as sbnr was associated with worse physical and mental health relative to youth that were consistently religious. using parametric mediation analyses, we found evidence that three of our four proposed mediators (religious attendance, sense of closeness to god, and religious doubt, but not life meaning) partially explained these mental health differences. this study therefore makes an important advance in assessing the health implications of (non)-religion/spirituality early in the life course.     

title_index:
       changes in spiritual but not religious identity and well-being in emerging adulthood in the united states: pathways to health sameness?     

full_text_index:
       journal of religion and health (2022) 61:4635–4673 https://doi.org/10.1007/s10943-022-01540-6 original paper  changes in spiritual but not religious identity and well‐being in emerging adulthood in the united states: pathways to health sameness? laura upenieks1 · joanne ford‐robertson2 accepted: 26 february 2022 / published online: 17 march 2022  the author(s), under exclusive licence to springer science business media, llc, part of springer nature 2022  abstract the “spiritual but not religious” (sbnr) are a growing group in the religious landscape of the united states. thousands of studies to date have been devoted to the study of religion and health, but far less attention has been given to the study of the “spiritual but not religious.” in this study, we address this gap by using two waves of longitudinal data from the national study of youth and religion (2005–2008). we assess whether within-person changes in sbnr identity are associated with health and mental health in emerging adulthood and consider several pathways that may account for observed differences. results suggest that consistently identifying as sbnr was associated with worse physical and mental health relative to youth that were consistently religious. using parametric mediation analyses, we found evidence that three of our four proposed mediators (religious attendance, sense of closeness to god, and religious doubt, but not life meaning) partially explained these mental health differences. this study therefore makes an important advance in assessing the health implications of (non)-religion/spirituality early in the life course. keywords health · mental health · spiritual but not religious · parametric mediation · life course  introduction countless studies over the past several decades have documented the benefits of religiosity for health and well-being (see koenig et al., 2012; page et al., 2020 for a review). a considerable amount of research has shown that certain aspects of * laura upenieks laura_upenieks@baylor.edu 1  department of sociology, baylor university, 97326 one bear place, waco, tx 76798, usa  2  department of sociology, university of texas at san antonio, san antonio, usa  13  vol.:(0123456789)  
  4636  journal of religion and health (2022) 61:4635–4673  religiosity, especially participation in a religious community, tend to have a protective influence on health and mental health (e.g., vanderweele, 2017). however, recent studies have challenged this finding of a generally beneficial association between religiosity and health. as several scholars have pointed out, existing studies have failed to compare people committed to non- or irreligious identities to those who strongly identify with religion, but instead tend to compare religious individuals to non-religious individuals without assessing how affirmative one’s commitment (see galen & kloet, 2011; hwang et al., 2011). a few recent studies have complicated the general dose–response pattern between religiosity and health by documenting a curvilinear relationship between religious/non-religious commitment and health (weber et al., 2012; zuckerman et al., 2016). taken together, these studies show that while being both spiritual and religious (actively participating in a religious community and having strong religious convictions) does indeed associate with better health, so too does holding an affirmative non-religious identity that is detached from formal religious participation (galen & kloet, 2011). one group of people that do not hold an organizational religious commitment that have increasingly gained the attention of sociologists are those who identify as “spiritual but not religious” (sbnr).1 these individuals are generally neither devoted atheists nor devout believers, but instead occupy a middle space between these positions. in the american religious climate, there has been a notable increase in those claiming to be sbnr (baker & smith, 2015; hastings, 2016; willard & norenzayan, 2017). for instance, in 2012, 18% of americans claimed to be sbnr (pew research center, 2012), a figure which rose to 27% as of 2017 (lipka & gecewica, 2017). based on these trends, the pew report of the 2014 religious landscape study asserted that the united states is becoming more spiritual and less religious in general. while these trends toward being spiritual but not religious are true across the entire spectrum of the american populace, identifying as sbnr has become increasingly popular among younger segments of the population. at this stage of the life course, many young adults are in search of highly individualistic beliefs and express a desire to distance themselves from religious institutions (arnett & jensen, 2002; packard & ferguson, 2019). accompanying this turn away from traditional sources of authority, there is now greater cultural value placed on teaching children to “think for themselves” (hout & fischer, 2014) rather than be constrained by any one set of religious doctrines. despite these broader cultural shifts, research on the health outcomes of this group have not kept pace with their exponential rise in numbers. the sbnr are an intriguing population to consider in probing the complex  1 whether or not a bifurcation of spirituality and religion is accurate or useful, there seem to be multiple dimensions and types of spirituality, thus contributing to the lack of clarity regarding what it means to be “spiritual” (helminiak, 2008; worthington, 2012). however, when people speak of spirituality in the united states today, they are often referring to the personal, internalized, emotional experience of the transcendent (hill & pargament, 2003). following an extensive review of the literature, moore (2017) added to this description and concluded that spirituality might best be very broadly defined as a “personalized, subjective commitment to one’s values of connection with self, others, nature, and the transcendent” (p. 23).  13  
  journal of religion and health (2022) 61:4635–4673  4637  relationship between religion and health, and its popularity as an identity among american youth make it essential to examine the phenomenon of being sbnr at this early life course stage and any implications this may hold for well-being. in undertaking such a task, it is important to investigate whether sbnr is an endpoint on a person’s life journey, or instead a pathway to becoming not religious. on this point, it is unclear how stable the sbnr identity is at an early life course stage (ammerman, 2013; johnson et al., 2013; mercadante, 2014). a recent study of adolescents shows that more than a quarter of respondents switched from being sbnr to either religious or neither religious/spiritual over a five-year period (tong & yang, 2018). the instability of the sbnr identity might be partially due to the changing nature of adolescents’ religious identities, especially as they undergo major life transitions such as leaving the parental home (hardie et al., 2016) or entering college (uecker et al., 2007). as a first study objective, then, we assess whether within-person changes in sbnr identity are associated with health and mental health in the period of the life course known an “emerging adulthood” when individuals are between 18 and 29 years of age. as a second study objective, we test several pathways that may account for an association between changes in sbnr identity and health and mental health. scholars have called for an assessment of mechanisms that could link secularity to health outcomes (may, 2018; walker et al., 2021). we posit four candidate mechanisms, which as we expound on, could link sbnr identity to health and mental health, including corresponding changes in religious attendance, feelings of closeness to god, religious/spiritual doubt, and life meaning. using two waves of data from the national study of youth and religion (nsyr) (2005–2008) that capture youth as they are entering adulthood, we assess how stability and change in the sbnr identity are associated with both physical and mental well-being relative to those who are stably religious and spiritual. we acknowledge that the two waves of data spanning emerging adulthood in the nsyr are now over a decade old, and it is possible that the processes leading youth to become sbnr have changed. the nsyr is, however, to the best of our knowledge the only data set that has sbnr identity measured at multiple time points along with health and mental health and several other important facets of religious life. nevertheless, throughout this study, we are careful to emphasize in our conclusions how recent changes the religious landscape of the united states might impact our results.  literature review defining the sbnr before delving into a consideration of how the spiritual but not religious may fare on outcomes related to well-being, we first provide an overview of how the sbnr group is defined and to gain a sense of what religious/spiritual practices they participate in. many studies have shown that the sbnr differ from traditionally religious people. comparatively speaking, sbnr people are less engaged in institutionalized  13  
  4638  journal of religion and health (2022) 61:4635–4673  religious activities, such as attending worship services or being religious affiliated; in lieu of more traditional religious practices, sbnr individuals tend to seek out mystical experiences and intentionally pursue a variety of spiritual activities in nonreligious settings (saucier & skrzypinska, 2006; wink et al., 2007; zinnbauer et al., 1997). however, recent scholarship suggests that the sbnr are a heterogeneous group with diverse understandings of religion/spirituality and different degrees of formal religious participation (ammerman, 2013; tong & yang, 2018). a latent class analysis of youth conducted by tong and yang (2018) identified four different subgroups among adolescents identifying as sbnr: (1) conventionally religious (attend church and pray often, have a close relationship with god; 26%), (2) moderately religious (attend church and pray regularly, not enthusiastic about a personal connection with god; 41%), (3) spiritual seekers (attend church and pray occasionally, pick and choose religious beliefs; 8%) and (4) religiously indifferent (do not attend church or pray, and do not have a personal connection with god; 25%). therefore, based on this research, it is important to recognize that sbnr identity and traditional religiosity should not be viewed as mutually exclusive. further cementing this evidence, a representative survey of adults in the united states found that 60% of sbnr individuals describe themselves as religiously affiliated (compared with 75% of all adults), 27% reported that religion was important to them, and nearly 1 in 5 sbnrs attended religious services at least once per week (pew research center, 2014). while an sbnr identity is associated with lower religiosity than the general american population, it is important to recognize that the sbnr are far from monolithic in their religious identities, attitudes, and behaviors. situating the sbnr in the religion/health relationship thousands of studies to date have been devoted to the study of religion and health, but far less attention has been given to the study of the spiritual but not religious. despite calls to address this gap in this research literature, much less progress has been made on this front. since the sbnr comprise a growing segment of the american population (galen, 2015; speed & fowler, 2017), this group is deserving of far greater attention. one reason to study those who identify with a spiritual but not religious identity is that it provides a way to extend research on the well-established relationship between religion and health. more specifically, by comparing spiritual individuals who place a lower priority on those formal aspects of religion (baker & smith, 2009) with those who remain highly committed to the formal aspects of religiosity, we can arrive at a more robust conclusion on which aspects of r/s may be associated with more favorable well-being. altogether, the limited research on the spiritual but not religious and health reveals a complex relationship. in perhaps the most comprehensive study to date, baker et al. (2018) found the “spiritual but not religious” are at elevated risks for both physical and mental health problems relative to affiliated theists. however, baker et al. (2018) relied on cross-sectional data, and were not able to assess changes over time in sbnr identity. they also did not consider the mechanisms  13  
  journal of religion and health (2022) 61:4635–4673  4639  through which differences between these groups arose, though they speculate that identity uncertainty and a lack of group structure (e.g., religious community) might be underlying these findings. previous authors have suggested that those moving away from religion could find themselves caught in between the religious and the never religious, struggling to find their own ingroup (engelman et al., 2020; van tongeren et al., 2019). building on this study by baker and colleagues (2018), research by walker et al. (2021) found that some types of “theistic nones” do well on a general health metric. using several waves of data from the general social survey, walker and colleagues add to previous research by differentiating between high certainty non-affiliated theists (i.e., theistic nones) and low certainty, non-affiliated theists (i.e., doubting nones), showing that there may be important differences between these sub-groups. high certainty of belief in god, even when combined with a lack of religious affiliation, may reduce psychosocial stress related to personal identities and thus produce better mental health outcomes. transitions in sbnr identity and well‐being the question of whether being sbnr associates positively or negatively with health is particularly vexing at the early stages of the life course as people transition into adulthood. some of the large-scale rise in the number of americans identifying as “spiritual but not religious” show trends of decreased religious engagement among younger people specifically (twenge et al., 2016; pew research center, 2019). research among university students, for instance, found that 20.75% identified as sbnr (marshall & olson, 2018), which is lower than the rate in the general american population. on the one hand, college may also be a time of religious growth for some individuals. according to lee (2002), more than one-third of college graduates experience an increase in faith during college. indeed, some studies have shown educational attainment has been shown to be positively associated with mainstream activities (schwadel, 2011; uecker et al., 2007). college students, however, also face a developmental transition involving increased independence and exposure to diverse worldviews (smith & snell, 2009). this could precipitate changes in religious engagement or identity (bryant et al., 2003; mueller, 2012). from a developmental perspective, college students are often working through issues related to identity and intimacy (erikson, 1950), which could include their religious identity and bonds with religious communities once college is completed. research specific to the early stages of the life course found that those who were religiously affiliated but had weak beliefs and low religious identity salience had the highest levels of emotional disorders (meltzer et al., 2011). likewise, young adults who are “spiritual but not religious” have higher levels of negative affect (jang & franzen, 2013). therefore, the question of whether, and how, fluctuations versus stability among the sbnr might associate with health and mental health is important to consider. it is important to acknowledge here that stability in the sbnr identity over time may, on one hand, represent certainty or conviction in one’s ability to seek spiritual understanding largely outside the context of religious congregations. on the other hand, however, the consistent acknowledgement of spiritual concepts  13  
  4640  journal of religion and health (2022) 61:4635–4673  without the formal institutional religious backing might only serve to provide a protracted time frame for the accumulation of deficits (e.g., social support, feelings of closeness to god), relative to the consistently religious. since the literature reviewed above offers mixed evidence for how sbnr identity may associate with health, and because no study has examined transitions in sbnr status and health over time, we leave this as an open question that could produce either direction of association: hypothesis 1 those consistently identifying at sbnr will report better or worse health and mental health than the consistently religious. hypothesis 2 those who report being sbnr at any one point will report better or worse health and mental health than the consistently religious.  mechanisms explaining differences in well‐being by spiritual/ religious identity we outline four likely mechanisms to potentially explain how changes in the sbnr identity may work through (a) religious attendance, (b) closeness to god, (c) religious doubt, and (d) sense of meaning in life to produce disparate health and mental health outcomes relative to consistently religious youth. religious attendance one factor that influences the beneficial relationship between religious and health is the social support that is found within a religious community (baker et al., 2018; fenelon & danielsen, 2016; vanderweele et al., 2016). communal participation in religion has been associated with less risky health behaviors such as alcohol use, smoking, and physical activity (degenhardt et al., 2007; gillum & ingram, 2006). moreover, frequent participants in religious communities have more social ties and receive higher levels of support from their social ties (ellison & george, 1994). a consistent finding within the literature is that religious social ties and the support which flows from a religious community tends to be one of the strongest protective factors linking religion to well-being and mortality (li et al., 2016; lim & putnam, 2010). while it may be assumed that sbnrs have less social support since an sbnr identity is associated with decreased religious participation (zinnbauer et al., 1997), recent research has shown that sbnrs should not be considered loners who lack social connections. as hastings (2016) found, sbnrs actually report similar levels of social connectedness when compared with those who regularly attend religious services. for many individuals who identify as sbnr, conflict in the church may have been one reason leading to their disaffiliation (bradley et al., 2016; exline et al., 2020). nevertheless, since religious attendance confers access to health benefits and reduce cognitive dissonances for those that are still somewhat inclined spiritually, the balance of evidence leads us to hypothesize the following:  13  
  journal of religion and health (2022) 61:4635–4673  4641  hypothesis 3 more frequent religious attendance will partially explain the health and mental health differences between the consistently sbnr and the consistently religious. closeness to god closeness to god is a commonly employed construct that captures an individual’s perception of how much support and reciprocity exist in their relationship with god (proeschold-bell et al., 2014). to date, a number of empirical studies have documented a positive association between closeness to god and both mental and physical health (culver & denton, 2017; hill & pargament, 2003; proeschold-bell et al., 2014). individuals holding an sbnr identity, however, are generally more likely to perceive that god is both impersonal and distant to them (johnson et al., 2018; mcclure, 2017), which could bear negatively on their health. for instance, it is possible that not believing in god, or acknowledging a god who is impersonal, might lead to higher health and mental health risk, while belief in a close, engaged, and supportive god might portend better well-being. empirical evidence tends to support these assertions. for instance, work by exline and colleagues (2020) found that the sbnr were the group most likely to intellectually question god’s existence. it is possible that questioning god’s existence promotes disengagement from religious communities, but it is also possible that disengaging from formal religious participation could also portend divine struggles. regardless of the order in which this process occurs, the process of coming to view god as distant from daily life could increase doubt about whether god exists (exline et al., 2012, 2015). therefore, because a transition to identifying as sbnr might portend lower feelings of closeness to god, this may account for another pathway as to why we might expect those who are consistently religious to report higher well-being: hypothesis 4 higher levels of closeness to god will partially explain the health and mental health differences between the consistently religious compared to the consistently sbnr. religious doubt religious doubt refers to experiences of conflict, tension, or distress around religious/spiritual matters (stauner et al., 2016) and have been linked with declines in mental and physical health (bryant & astin, 2008; upenieks, 2021; wortmann et al., 2012). while uncertainties of faith are fairly common among those reporting a religious community (wilt et al., 2017), those identifying as nonreligious are not immune from such doubts (stauner et al., 2015). because spirituality also accompanies the existential questions that all humans grapple with, including questions of selfhood, ultimacy, meaning, and death and suffering, the validity of any spiritual worldviews may be prone to doubt even if removed from formal religious institutions. people who have disaffiliated from formal  13  
  4642  journal of religion and health (2022) 61:4635–4673  religion—whether through a gradual or traumatic break—may believe themselves to have escaped such doubt, but generally encounter them anyways (mercadante, 2014). the break from formal religious institutions can be a difficult process, as community and family support could be lowered or withdrawn. on an idealistic level, as new beliefs emerge, experimentation with different spiritual beliefs and practices may generate internal conflict (mercadante, 2014). prior research among a sample of university students suggests that the sbnr may be subjected to the highest levels of religious doubt compared to the consistently religious or those who are completely non-religious (exline et al., 2020), perhaps due in part to their liminal identity which still affords some importance to spiritual matters that like any belief system are subject to doubt and questioning. though there are several spiritual matters which may prompt internal doubt among the sbnr, two of the most common are doubts regarding the divine and feeling alienated from others in society who still hold religion as important. first, many sbnrs continue to doubt their beliefs about god long after they made the move away from institutionalized religion (szczesniak et al., 2020; vittengl, 2018), and report difficulty in conceiving of their relationship to a divine power, to the transcendent, or to some other entity larger than themselves. some sbnrs attempt to resolve this issue by using a form of “horizontal transcendence” (mercadante, 2014), that is, feeling a part of humanity, the cosmos, or some other immanent universal energy source. qualitative accounts, however, suggest that this process of horizontal transcendence is especially difficult for those raised in a religious context who retain a lingering concept of god. these individuals tend to express alienation from this divine entity that they now consider distant at best or untrustworthy or ineffective at worst (mercadante, 2014). related to our second proposed mechanism of feelings of closeness to god, some sbnrs may doubt with their decision to give up on the idea of a personal god who is a close confidant and directly involved in daily life and grappling with such a decision may be associated with lower well-being. second, some sbnrs may also feel alienated, or marginalized, especially in the united states which still considers religion important (sedlar et al., 2018). this may cause doubt because it may be difficult to judge one’s place in relation to others in society. some of those identifying as sbnr report being judged or pitied by close friends or family members for not having the solace that a religious community is thought to offer (mercadante, 2020). despite being satisfied with their overall transition out of western religion, still sbnrs may still face a temporary difficulty with finding a place in the larger american society. to the extent that the consistently or transient sbnr experience both higher interpersonal and theological doubts than the consistently religious, which could undermine their health and well-being. hypothesis 5 higher levels of religious/spiritual doubt will partially explain the health and mental health differences between the consistently sbnr and the consistently religious.  13  
  journal of religion and health (2022) 61:4635–4673  4643  sense of meaning in life religion is often thought to be a main source of meaning for individuals (park, 2005) because belief systems originating in the religious content appeal to an “ultimate source” (e.g., god or a divine power) (crescioni & baumeister, 2013). park and mcnamara (2006) argue that religious frameworks provide a comprehensive and “existentially satisfactory” source of meaning relative to secular sources of meaning, which tend to draw on more objective explanations for where meaning originates from (farias et al., 2013). religious beliefs, including belief in god or a divine power, hope in the afterlife, and the belief that life unfolds according to a cosmic plan is associated with a greater sense of meaning in life and is also linked to health and mental well-being (galek et al., 2015; shiah et al., 2015). given their pattern of disaffiliation from formal religious practices, some have assumed that sbnr individuals are bereft of a larger sense of meaning and purpose in life (hughes, 2012). this view, however, has been challenged by others who have argued that humans are evolutionarily hardwired to find meaning in life (coleman & hood, 2015), and that this process does not fall wholly under the purview of a specific religious or philosophical framework. consistent with this line of work, there is some recent evidence which suggests that the religiously unaffiliated do not experience deficits in the sense of meaning in life (caldwell-harris et al., 2011; speed et al., 2018). manning’s (2013, 2015) qualitative studies of non-religious individuals have identified a number of alternative sources that non-religious individuals utilize to shape their worldviews, including involvement in socio-political issues and organizations. while this previous research has focused on those reporting an identity completed removed from religious belief and practice, how might this process unfold for the sbnr? sbnrs tend to report higher levels of ultimate meaning struggles compared to those who are more religiously engaged or who report a nonreligious identity (exline et al., 2021). in young adulthood, the questioning of religious meaning systems in which they were raised in may cause struggles in identifying alternative belief systems through which to hold close. for the subset of sbnr individuals who pull back from organized religion, they could experience at least temporary struggles in meaning as they lose a direct connection to the sacred (park, 2013). any attempt to find or select an alternative meaning system could require considerable effort, and the associated uncertainty around worldviews could be a substantial source of stress. based on this evidence, we propose that: hypothesis 6 higher levels of life meaninglessness will partially explain the health and mental health differences between the consistently sbnr and the consistently religious. figure 1 displays a conceptual model of all pathways tested in the current study.  13  
  4644  journal of religion and health (2022) 61:4635–4673  potential mechanisms religious attendance closeness to god religious doubt life meaning  consistently sbnr depression self-rated health consistently religious  fig. 1 conceptual framework of mediation pathways to explain health and mental health differences between the consistently sbnr and the consistently religious. mediation models test whether the four proposed mediators explain the differences in depression and self-rated health between the consistently sbnr and the consistently religious  data and methods we draw on data from wave 2 (2005–2006) and wave 3 (2007–2008) of the national survey of youth and religion (nsyr), which provide an opportunity to look at changes in sbnr identity as well as several religious mediators of interest. the nsyr was a longitudinal telephone survey that was launched as a nationally representative sample of english and spanish speaking teenagers between the ages of 13 and 17 at the beginning of the survey. the baseline survey (2002–2003) was conducted with these teen respondents and one of their parents by researchers at the university of north carolina at chapel hill. a random-digit dial (rdd) telephone method was used to generate numbers representative of all household telephones in the 50 united states, and 3370 cases were completed at wave 1 (57% response rate). subsequent waves of the nsyr followed the wave 1 english-speaking teen respondents over time. wave 2 was conducted from june 2005 through november 2005, when the initial respondents were aged 16 and 21, and wave 3 was conducted in 2007–2008 when respondents were between 18 and 23 years of age. we elected to focus on waves 2 and 3 because as teens transition to emerging adults, they become more independent from their parents and gradually form their own distinct set of beliefs from their parents’ beliefs (arnett & jensen, 2002; smith & snell, 2009). beyond this restriction, the analytic sample included all cases who provided a productive interview at wave 2 and wave 3 and had a valid longitudinal weight, used in all analyses to increase representativeness. multiple imputation with chained equations were used to impute 50 data sets, and estimates were averaged across these datasets according to rubin’s rules (royston, 2005) using the mi estimate command in stata 15. to produce consistent samples across the two dependent variables, values were not imputed for those missing on either of the dependent variables (self-rated health and depression) (von hippel, 2007). this procedure yielded a final analytic sample of 2,238 cases.  13  
  journal of religion and health (2022) 61:4635–4673  4645  dependent variables two dependent variables were used in this study. the first is a measure of depression, an indicator of mental well-being that was available at the second and third waves of the nsyr. only a one-item measure of mental health was available at waves 2 and 3 of the nsyr. this item measuring feelings of sadness and depression is worded, “how often do you feel sad or depressed?” the response categories ranged from 1 “never” to 5 “always.” second, we also use a measure of self-rated physical health, measured with the same question at waves 2 and wave 3 of the nsyr. respondents were asked, “overall, would you say your health is _______?” response options were coded so that higher scores represent better self-rated health, where 1 “poor,” 2 “fair,” 3 “good,” 4 “very good,” and 5 “excellent.”  focal independent variable measuring “spiritual but not religious identity”: respondents’ spiritual but not religious identity was self-reported at wave 2 and wave 3. they were prompted with the following question: “some people say that they are ‘spiritual but not religious.’ how true or not would you say that is of you?” responses were coded where 1 “very true,” 2 “somewhat true,” and 3 “not true at all.” respondents answering “very true” or somewhat true” were coded as having a sbnr identity at each time point. this measurement of sbnr identity differs somewhat from that employed by most prior studies which have typically used a 4-group typology composed of crossed, binary indicators of religiosity and spirituality, i.e., respondents may be religious and spiritual, sbnr, religious but not spiritual, or not religious and not spiritual (see chaves, 2011; jang & franzen, 2013; zhai et al., 2008). other studies have modified this typology by collapsing both religious categories (johnson et al., 2018) or by focusing on the comparison between sbnr and the religious and spiritual (zinnbauer et al., 1997). though different from prior measurement, the three-part typology used in this study offers the advantage of moving beyond binary classifications of the relevant constructs (ammerman, 2013), capturing potentially important variation in the degree to which individuals identify as sbnr. an identical approach was used by seto (2021) with the nsyr data. the primary drawback to this approach is the potential for reference group heterogeneity; for example, religious and spiritual, religious but not spiritual, and not religious, not spiritual people may all respond that they are “not at all” sbnr. however, this self-classification system as “spiritual but not religious” represents a simple overall measure which gives information about an individual’s personal and social identity at this early life course stage. moreover, it allows a differentiation between the diverse types of (non)-religiosity, which cannot be measured with the most frequently used variables such as an overall scale of religiosity (ranging from very religious to not  13  
  4646  journal of religion and health (2022) 61:4635–4673  religious), behavioral variables (e.g., the frequency of religious attendance), or variables on values (e.g., the importance of god(s) in one’s life). to capture our main independent variable of interest, change in sbnr identity, we created four categories: (1) those who reported being consistently religious (i.e., they did not report being sbnr at either wave) which served as our reference group in all analyses, (2) those who lost their sbnr identity (sbnr at wave 2 only), (3) those who became sbnr (sbnr at wave 3 only), (4) those who were consistently sbnr at both waves. given the limitations of our measure of sbnr described above, those who were (1) consistently religious had to report a belief in god at both wave 2 and 3. mediating mechanisms religious attendance: religious attendance was operationalized using a question about frequency of attendance at religious services. seven response categories were available, ranging from no attendance to “more than once a week.” we eventually collapsed this variable into the following categories: 1 “never/a few times a year [reference group],” 2 “many times a year/once a month,” and 3 “2–3 times a month, and 4 “weekly or more.” closeness to god at both waves, respondents were asked, “how distant or close do you feel to god most of the time?” with seven possible response categories ranging from “do not believe in god” (coded as 0) to “extremely close” (coded as 6). we coded this as into a four-category variable to ensure adequate cell size, where 1 “extremely distant/very distant [reference group],” 2 “somewhat distant,” 3 “somewhat close,” and 4 “very close/extremely close.” respondents who reported not believing in god at either wave received a score of “0” on this measure (n 105 at wave 1, and n 149 at wave 3). religious doubt this was assessed by a one-item measure at wave 3 of the nsyr. respondents were asked, “in the past year, how many doubts, if any, have you had about whether your religious beliefs are true?” response options were coded according to the following scheme: 1 “no doubts,” 2 “a few doubts,” 3 “some doubts,” 4 “many doubts.” higher scores represent greater religious doubt. life meaninglessness this was operationalized using respondents’ perceptions that life is meaningless, as prior research has shown that meaning making is a crucial dimension of religious coping. perceptions of meaninglessness were measured by asking, “how often, if ever, does life feel meaningless to you?” to ensure adequate cell size across categories, responses were coded where 1 “rarely/ never, [reference group],” 2 “sometimes,” and 3 “often/fairly often.” here, higher scores indicate greater meaninglessness in life (or less meaning), as perceived by the respondent. we also note that since parametric mediation analyses (described below) are unable to accommodate categories of change scores as a mediator, we use levels of the mediator at wave 3 (our second study time point) for each of the four pathways we  13  
  journal of religion and health (2022) 61:4635–4673  4647  analyzed, as this was the attained level of each mediator in between study waves. however, we do include an adjustment for the wave 2 level of each mediator in all analyses pertaining to parametric mediation. control variables several sociodemographic control variables were also adjusted for in our analyses. controls included sex and age (ranging from 16 to 20 years at wave 2). race was coded as a binary variable because of small cell sizes in some racial groups; we therefore contrasted non-hispanic whites (1) with non-hispanic black, hispanic, and other race (0). results were substantively similar if race was treated as a fourcategory variable. we also adjusted for whether or not a respondent had completed or was enrolled in a four-year college.2 we also adjust for a respondent’s religious affiliation. here, we contrast conservative protestant (reference group) with mainline protestant, black protestant, catholic, jewish, mormon/lds, other/indeterminate, and the religiously unaffiliated. we also control for several variables at the family level, as they could be associated both with health and mental health, as well as with transitions into/out of a sbnr religious identity. these variables were measured at wave 1 of the nsyr. first, parental education was operationalized using questions which asked the responding parent about their educational attainment and their partner’s educational attainment, when applicable. the higher educational attainment was taken from these answers and used to represent parental education for that family. categories for this measure are coded as 1 “bachelor’s degree or higher” versus 0 “all else” for simplicity. second, we included an adjustment for parental divorce. past research has found that when organized religion fails as a safeguard to protect families from divorce, individuals are perhaps less inclined to be religious and may gravitate toward an sbnr identity (ellison et al., 2011; zhai et al., 2008). additional analyses also included an adjustment for a binary variable of urban/ rural residence, but results were unchanged. we therefore did not include this variable in our final models.  plan of analysis analyses used a lagged dependent variable (ldv) approach. models thus included a control for wave 2 depression when predicting wave 3 depression and wave 2 selfrated physical health when predicting wave 3 self-rated physical health. such an approach allowed for an examination of how changes in spiritual but not religious  2 in college, individuals might find support for “spiritual seeking,” that is, seeking religious identities outside of formal religious institutions. additional analyses revealed that an interaction of college attendance*categories of sbnr identity failed to reach significance with either health or mental health taken as the outcome. therefore, the results we report below do not differ for college students vs. noncollege students.  13  
  4648  journal of religion and health (2022) 61:4635–4673  identity are associated with physical and mental health at wave 3, net of baseline levels of each respective indicator of well-being. ols regression is used for analyses related to depression, and ordinal logistic regression for models assessing self-rated physical health. with respect to the latter, additional analyses showed that the proportional odds assumption was not violated (as evidenced by a non-significant brant test in stata 15), so we could proceed with the ordinal logit model specification. the ldv model is advantageous because it helps prevent endogeneity bias, which would occur if health or depression at wave 2 was a strong predictor of religious doubt at wave 3. moreover, an ldv approach helps ensure unbiased coefficients because it adjusts for the autocorrelation between measures of health at both time points. while some scholars have recommended fixed effects models over ldv models because they control for any unobserved static characteristics (e.g., johnson, 2005), recent evidence using monte carlo simulations has shown that ldv models in a regression framework generally produce accurate estimates with no more bias introduced than alternative estimation strategies (wilkins, 2018). moreover, critiques of ldv models argue that such models are more likely to cause type 2 error, suppressing significant effects rather than artificially inflating them (achen, 2000). in the latter case, ldv models would likely yield more conservative estimates regarding the focal relationship between changes in sbnr identity and well-being in this study. sample attrition is also a concern in longitudinal data. an inverse probability weight was created and applied to the analyses. “absent from the sample at wave 3” was regressed using probit regression on all time stable and baseline (wave 2) variables. predictions were then transformed to obtain the mills inverse ratio and included in all analyses (coefficient not shown in tables). results were consistent, however, whether or not the mills inverse ratio was included in the analyses. finally, to formally test for mediation, parametric mediation methods in the counterfactual framework were used (through the paramed command in stata 15) (emsley & liu, 2013). this process builds upon the traditional baron and kenny (1986) mediation procedure and uses counterfactual definitions of direct and indirect effects. estimates from two parametric regression models are used to construct the controlled direct effect (cde), the natural direct effect (nde), and the natural indirect effect (nie), the latter of which is the focus of typical mediation analyses. the natural indirect effect is calculated with respect to the mediator, controlling for all study covariates (see valeri & vanderweele, 2013). the natural indirect effect assumes that exposure is set to some level a and then compares what would have happened if the mediator were set to an alternative value a*. moreover, 95% confidence intervals were calculated using the default delta method, after verification that results using bootstrapped intervals were essentially identical. according to valeri and vanderweele (2013), the estimates will take a causal interpretation in the absence of any residual confounding.  results we preface our main regression analyses by noting several key descriptive statistics. table 1 displays the full host of descriptive statistics for all variables included in our study, and we show means and proportions across categories of changes in  13  
  2.15  0.13 0.35  2–3 times a month or more  weekly or more  0.79  2.37  0.25 0.32 0.43 17.60  rarely/never  sometimes  often/fairly often  age, w2  life meaninglessness, w3  0.05  17.76  0.44  0.34  0.22  0.06  0.07 0.02  some doubts  many doubts  0.49 0.30  0.64 0.26  no doubts  a few doubts  religious doubt, w3*  0.31  0.33 0.43  somewhat close  very close/extremely close  0.23  0.30  0.11 0.13  0.16  0.05  0.17  0.11  0.67  3.77  3.62  2.41  extremely distant/very distant  1.30  0.93  0.93  0.76  somewhat distant  closeness to god, w3*  0.36 0.16  never attends/a few times a year  3.94  3.93  2.15  1.38  0.94  0.98  0.80  0.76  sd  mean/prop.  mean/prop  sd  consistently sbnr (n 850)  consistently religious (n 560)  many times a year/once a month  16, 20  1,5  1,5  self-rated health, w3 *  self-rated health, w2 *  religious attendance, w3*  1,5  1,5  depression, w3*  depression, w2*  range  table 1 study descriptive statistics, national study of youth and religion (n 2,238)  17.67  0.41  0.32  0.27  0.03  0.09  0.24  0.64  0.32  0.37  0.17  0.14  0.12  0.20  0.12  0.56  3.84  3.85  2.27  2.24  mean/prop.  1.33  0.97  0.93  0.84  0.70  sd  lose sbnr (n 336)  17.65  0.41  0.32  0.27  0.04  0.13  0.26  0.57  0.25  0.39  0.23  0.13  0.06  0.15  0.18  0.55  3.88  3.81  2.32  2.25  mean/prop.  become sbnr (n 492)  1.35  0.91  0.92  0.86  0.73  sd  journal of religion and health (2022) 61:4635–4673 4649  13  
  13 0.36  parental education (1 college)  0.54  0.14  no affiliation  0.19  0.17  0.01  0.07  0.17  0.18  0.02  0.05  0.19  0.08  0.07  0.25  0.37  0.45  0.64  0.57  0.46  mean/prop.  sd  lose sbnr (n 336)  *indicates a significant t test (means) or chi square test (proportions) between the consistently religious and the consistently sbnr  0.14  other/indeterminate  0.04  0.04 0.05  jewish  mormon/lds  0.22  0.06 0.16  black protestant  catholic  0.08  0.32 0.09  conservative protestant  0.23  0.36  0.45  0.69  0.55  mainline protestant  religious affiliation, w2*  0.74 0.32  college degree/enrolled in college  parental divorce *  0.46 0.66  sd  mean/prop.  mean/prop  sd  consistently sbnr (n 850)  consistently religious (n 560)  female*  range  race (white 1)*  table 1 (continued)  0.13  0.18  0.02  0.02  0.19  0.08  0.08  0.29  0.32  0.41  0.64  0.57  0.55  mean/prop.  become sbnr (n 492) sd  4650 journal of religion and health (2022) 61:4635–4673  
  journal of religion and health (2022) 61:4635–4673  4651  sbnr identity. first noting some basic characteristics of the sample, roughly half of our sample was female, and 73% of our sample was white. moreover, about 36% of respondents had completed or were enrolled in a four-year college program. for our two outcome variables, the average depression score at wave 3 was 2.32 on a 5-point scale, and 2.29 at wave 2. this shows that respondents had fairly similar levels of depression at each wave. as for self-rated physical health, most respondents fell into the “good” to “very good” response range at both waves. our hypotheses centered around how changes in sbnr identity between wave 2 and wave 3 were associated with changes in depressive symptoms and physical health. it is therefore worth noting that our modal category for change in religious/ spiritual identity was those consistently religious and spiritual (38% of the sample). meanwhile, 25% of respondents remained consistently sbnr across waves of the study. despite the stability in religious identity for these two groups, 14% of the sample reported being sbnr at wave 2, but no longer identified as such by wave 3. in addition, nearly one-quarter (22%) of the sample who did not identify as sbnr at wave 2 did so by wave 3. thus, many individuals at this relatively early stage of the life course shift whether or not they identify as spiritual but not religious. we also see some important differences emerge between the consistently religious and consistently sbnr, our two main groups of interest. significant t test (means) and chi-square tests (proportions) between these groups at the 0.05 alpha level are indicated by an * in table 1. descriptively, the consistently sbnr report higher depression and worse self-rated health than the consistently religious. unsurprisingly, the consistently sbnr are also less likely to attend religious services weekly compared to their consistently religious counterparts (5% versus 35%, respectively) and are less likely to feel close to god than youth not identifying as sbnr (23% versus 43%). the consistently religious are also less likely to have religious doubt than their consistently sbnr counterparts, though there were no differences in life meaning scores between the two groups. the consistently sbnr were also more likely to be female and white. to assuage concerns about the validity of the coding scheme we used to determine inclusion in our four categories, appendix 1 shows show religiosity measures across those who answered “not at all true” at wave 2 to the sbnr question, those who answered “somewhat or very true, at wave 2, and then the same two groups at wave 3 of the nsyr. we used five dimensions of religiosity that were measured consistently at both waves 2 and 3 and were also asked of all respondents (e.g., not just those who reported a belief in god). these dimensions are religious attendance, closeness to god, and religious doubt, which were focal mechanisms in the current study, as well as two additional dimensions, the frequency of private prayer and bible/scripture reading. as shown in appendix 1, it appears that our categorization of respondents into these different groups by using “not at all” to denote one as “religious” and “somewhat or very true” to denote one as sbnr maps onto religious practices and beliefs. indeed, respondents answering “not at all true” to the sbnr question had reasonably high rates of religious attendance and feelings of closeness to god, few doubts, and were more likely to engage in private prayer and bible scripture reading. the gap in religious beliefs and practices between the “not at all” and “somewhat true  13  
  4652  journal of religion and health (2022) 61:4635–4673  and very true” groups were lower for those religious activities deemed more “spiritual” and detached from formal religious participation, including closeness to god and the frequency of private prayer. for instance, at wave 2, as 46% of the consistently religious reported being very close or extremely close to god. this was the case as well for 39% of the “somewhat” or “very true” group. differences between these at the two highest levels of prayer frequencies ranged from 6 to 8%. these additional analyses provide reassurance that our decision to categorize respondents as we did is actually comparing religious versus spiritual but not religious characteristics of nsyr participants. results for depressive symptoms the first outcome variable of interest in this study was depressive symptoms, measured at wave 3. results are shown in table 2. model 1 shows that relatively to respondents that are consistently religious, those who were consistently spiritual but not religious report an increase in depressive symptoms between waves (b 0.08, p 0.05). notably, those who became sbnr or who lost their sbnr identity between waves did not have depressive symptom scores that were statistically distinguishable from the consistently religious. to help visualize predicted depression scores across these groups, we conducted an analysis of marginal effects, plotted in fig. 2. as shown there, they consistently have average depressive symptom scores of 2.24, significantly lower than the consistently sbnr (2.32). however, as can be seen by the overlap in the confidence intervals, no other two groups had statistically different average depression scores. this evidence from model 1, therefore supports hypothesis 1, but not hypothesis 2. the consistently sbnr have worse mental health than the consistently religious, but those who are more transient in their sbnr identity are not also at increased risk of depression. models 2–5 of table 2 sequentially introduce each mediator that we posited: religious attendance (model 2), closeness to god (model 3), religious doubt (model 4), and sense of life meaning (model 5). we were interested in which of our four mediators reduced the association between consistently sbnr and greater depression to non-significance. as can be seen, adjusting for religious attendance, feelings of closeness to god, and religious/spiritual doubt all rendered the association between a consistently sbnr identity and depression to non-significance. the sense of life meaning, introduced in model 5, had no such effect, as those who were consistently sbnr still reported greater depression scores here (b 0.10, p 0.05) relative to the consistently religious. while observing reductions in coefficients of interest to non-significance provides partial evidence of mediation, we formally test these mediating mechanisms using the parametric mediation techniques mentioned above. the results pertaining to these mediation analyses can be found in table 3. all mediation models below reference two groups: the consistently religious versus the consistently sbnr, since this is where the mediation pattern is detected in table 2. beginning with religious attendance in the first column of table 3, the natural indirect effect of religious attendance in the relationship between being  13   0.01 (0.05) 0.06 (0.04)  0.08* (0.04)   0.04 (0.03)   0.14*** (0.04)  race (white 1)  college degree/enrolled in college  0.03** (0.01)  0.12*** (0.03)  age, w2  female  covariates  often/fairly oftene  sometimese  life meaninglessness, w3  many doubtsd  some doubtsd  a few doubtsd   0.14 (0.04)   0.05 (0.03)  0.13*** (0.03)   0.16 (0.04)   0.06 (0.04)  0.10** (0.03)  0.03* (0.01)   0.19* (0.07)  religious doubt, w3  very close/extremely close  0.01 (0.07)  0.01 0.07   0.01 (0.05)  0.06 (0.05)  0.38*** (0.02)  model 3   0.11 (0.07)  0.04** (0.01)   0.07 (0.05)   0.05 (0.06)   0.05 (0.05)   0.01 (0.05)  0.01 (0.05)  0.37*** (0.02)  0.01 (0.05)  0.37*** (0.02)  model 2  somewhat close c  somewhat distantc  closeness to god, w3  weekly or m  oreb  2–3 times a month or moreb  many times a year/once a m  onthb  religious attendance, w3  consistently sbnra  become sbnra  lose sbnra  change in sbnr identity  depression, wave 2  model 1   0.14*** (0.04)   0.04 (0.03)  0.13*** (0.03)  0.04** (0.01)  0.15*** (0.04)  0.22*** (0.04)  0.07 (0.04)  0.06 (0.04)  0.01 (0.05)  0.02 (0.05)  0.36*** (0.02)  model 4   0.14*** (0.04)   0.03 (0.04)  0.13*** (0.03)  0.03** (0.01)  0.15** (0.05)  0.13*** (0.05)  0.10* (0.04)  0.02 (0.05)  0.04 (0.05)  0.37*** (0.02)  model 5  table 2 ordinary least squares regression models predicting depressive symptoms at wave 3, national study of youth and religion (standard errors shown in brackets n 2238)  journal of religion and health (2022) 61:4635–4673 4653  13  
  13  f  compared to rarely/never  compared to no doubts  compared to extremely distant/very distant  compared to never/a few times a year  compared to consistently religious  compared to conservative protestant  e  d  c  b  a  ***p .001, **p .01, *p .05,  no affiliationf  other/indeterminatef  mormon/ldsf  jewishf  catholicf  black protestantf  mainline protestantf  religious affiliation, w2  parental education (1 college)  parental divorce  table 2 (continued)  0.05 (0.06)  0.02 (0.17) 0.01 (0.04) 0.05 (0.07)  0.02 (0.09) 0.06 (0.10) 0.09 (0.06)  0.12 (0.17)  0.02 (0.04)  0.06 (0.07)   0.04 (0.09)  0.10 (0.10)  0.11* (0.05)  0.01 (0.04)  0.06 (0.04)  model 2  0.05 (0.06)   0.01 (0.05)  0.05 (0.03)  model 1  0.08 (0.06)  0.09 (0.11)  0.01 (0.11)  0.01 (0.08)   0.01 (0.05)   0.22 (0.17)  0.01 (0.07)  0.01 (0.05)  0.04 (0.04)  model 3  0.12** (0.05)  0.12 (0.10)   0.02 (0.09)  0.04 (0.07)  0.01 (0.04)  0.04 (0.17)  0.04 (0.06)   0.01 (0.04)  0.05 (0.03)  model 4  0.16** (0.05)  0.08 (0.11)   0.02 (0.11)  0.05 (0.07)  0.03 (0.05)   0.08 (0.19)  0.05 (0.06)  0.01 (0.05)  0.04 (0.04)  model 5  4654 journal of religion and health (2022) 61:4635–4673  
  journal of religion and health (2022) 61:4635–4673  4655  2.45  depressive symptoms, wave 3  2.4 2.35 2.3 2.25 2.2 2.15 2.1 2.05 2 consistently religious  lose sbnr  become sbnr  consistently sbnr  changes in religious/spiritual identity, w2 -w3 fig. 2 depressive symptoms across changes in religious/spiritual identity. estimates are derived from model 1 of table 2, holding all other covariates at their respective means. 95% confidence intervals displayed  table 3 parametric mediation analyses for depressive symptoms (changes in religious/spiritual identity) (n 2238)  controlled direct effect  religious attendance, w3  closeness to god, w3  religious doubt, w3 life meaning, w3  0.12 (0.08)   0.02 (0.08)  0.07 (0.08)  0.10 (0.10)  natural direct effect  0.06 (0.04)  0.06 (0.04)  0.06 (0.04)  0.09* (0.04)  natural indirect effect  0.03* (0.01)  0.02* (0.01)  0.03** (0.01)  0.00 (0.01)  total effect  0.09* (0.04)  0.09* (0.04)  0.09* (0.04)  0.08* (0.04)  ***p .001, **p .01, *p .05 (two-tailed tests) estimates are derived from a model adjusting for all study covariates a consistently religious, a* consistently sbnr  consistently sbnr is 0.03 (p 0.05). this suggests that depression scores would increase by 0.03 for the consistently sbnr if attendance scores were changed from the level that they would take for the consistently religious to the level they would take for the sbnr. to provide a sense of effect size of this indirect pathway, religious attendance explained 33% (indirect effect 0.03/total effect 0.09) of the influence of being consistently sbnr on depression scores over. to contextualize this finding further, 46% of the consistently religious attended religious services once a week or more, compared to only 19% of the consistently sbnr.  13  
  4656  journal of religion and health (2022) 61:4635–4673  moving to the second column of table 3, the natural indirect effect of closeness to god was 0.02 (p 0.05), which suggests that depression scores would increase by 0.02 for the consistently sbnr if closeness to god scores were changed from the level that they would take for the consistently religious to the level they would take for the sbnr. this pathway through closeness to god explained 22% of the effect of being consistently sbnr on depression scores. as with attendance, this pathway is also borne out empirically. for instance, 41% of the consistently religious reported high feelings of closeness to god at wave 3, compared with only 23% of the consistently sbnr. religious/spiritual doubt was the final mediator considered in the study. here again, we also saw a significant indirect effect (0.03, p 0.01). within the counterfactual mediation framework, this means that depression scores would increase by 0.03 for the consistently sbnr if religious doubt scores at wave 3 were changed from the level they would take for the consistently religious to the level they would take for the sbnr. this pathway explained 33% of the total effect of holding a consistent sbnr identity and depression. indeed, while only 8% of the consistently religious had “some” or “many doubts” about their religiosity/spirituality at wave 3, 21% of the consistently sbnr experienced this moderate/high level of doubt. finally, the last column of table 3 reveals that, as in table 2, the sense of life meaning did not have a significant indirect effect in the relationship between changes in religious/spiritual identity and depression.  results for physical health our second outcome variable was self-rated physical health, results of which can be found in table 4. odds ratios, as well as 95% confidence intervals, are presented for each ordinal logistic regression model. models proceed in an identical sequence to depression. as shown in model 1 of table 4, those who were consistently sbnr had lower physical health (or 0.64, p 0.001) relative to the consistently religious. figure 3 shows the predicted probabilities of being in the highest category of self-rated physical health (“excellent”) across each religious/spiritual identity transition. the consistently sbnr had the lowest likelihood of being in excellent physical health (predicted probability 0.21), nearly 7% lower than their consistently religious counterparts (predicted probability 0.28). as can be seen by the overlap in confidence intervals, the consistently sbnr did not have worse physical health relative to those who became sbnr by wave 3. nevertheless, those who lost their sbnr identity between waves 2 and 3 of the study had higher odds of being in excellent physical health (predicted probability 0.28) than the consistently sbnr (p 0.01). finally, those who became sbnr or lost their sbnr identity did not have statistically distinguishable health profiles from the consistently religious. therefore, as with depression, we see support for hypothesis 1 but not hypothesis 2. the consistently sbnr have worse physical health compared to the consistently religious, but those with more transient sbnr identities do not have physical health ratings that differ from the consistently religious.  13  
  0.88 (0.68–1.13) 0.67*** (0.54–0.82)  0.64*** (0.52–0.78)  1.03 (0.97–1.09)  0.96 (0.82–1.12)  1.13 (0.95–1.35)  age, w2  female  race (white 1)  covariates  often/fairly oftenf  sometimesf  life meaning, w3  many doubtse  some doubtse  a few doubtse  religious doubt, w3  very close/extremely closed  somewhat closed  somewhat distantd  1.13 (0.94–1.36)  0.98 (0.83–1.14)  1.03 (0.97–1.09)  1.50* (1.08–1.84)  closeness to god, w3  1.38* (1.01–1.88)  weekly or more  1.21 (0.95–1.54)  0.96 (0.74–1.24)  0.84 (0.66–1.07)  2.63*** (2.36–2.94)  0.93 (0.73–1.20)  2.62 (2.36–2.92)  model 2  2–3 times a month or more c  many times a year/once a m  onthc  religious attendance, w3  consistently sbnrb  become sbnrb  lose sbnrb  change in sbnr identity  excellent or very good health, w2a  self-rated health, wave 2  model 1  1.19 (0.96–1.46)  0.91 (0.76–1.09)  1.03 (0.96–1.46)  1.55 (1.07–2.24)  1.23 (0.89–1.71)  1.05 (0.777–1.31)  0.73** (0.58–0.92)  0.92 (0.70–1.22)  1.02 (0.77–1.37)  2.56*** (2.27–2.89)  model 3  1.14 (0.96–1.36)  0.95 (0.81–1.11)  1.01 (0.97–1.08)  0.94 (0.77–1.16)  0.81* (0.64–0.99)  0.81* (0.65–0.98)  0.766*** (0.53–0.81)  0.85 (0.66–1.08)  0.95 (0.73–1.21)  2.61*** (2.38–2.88)  model 4  1.15 (0.95–1.39)  0.93 (0.79–1.10)  1.03 (0.97–1.10)  0.99 (0.76–1.30)  1.00 (0.76–1.31)  0.63*** (0.51–0.78)  0.83 (0.64–1.08)  0.94 (0.71–1.23)  2.52*** (2.24–2.83)  model 5  table 4 ordinal logistic regression models predicting self-rated health at wave 3, national study of youth and religion (odds ratios and 95% confidence intervals shown, n 2238)  journal of religion and health (2022) 61:4635–4673 4657  13  
  13 0.99 (0.73–1.35) 1.03 (0.58–1.85) 1.01 (0.79–1.29) 1.47 (0.95–2.28) 1.09 (0.67–1.78) 0.41* (0.22–0.73) 1.12 (0.83–1.52)  0.93 (0.52–1.65)  0.99 (0.78–1.25)  1.41 (0.94–2.11)  1.15 (0.71–1.86)  0.39** (0.21–0.72)  1.03 (0.80–1.35)  compared to no doubts  compared to extremely distant/very distant  compared to never/a few times a year  compared to consistently religious  compared to fair/poor self-rated health  compared to conservative protestant  compared to rarely/never  g  f  e  d  c  b  a  ***p .001, **p .01, *p .05,  no affiliationg  other/indeterminateg  mormon/ldsg  jewishg  catholicg  black protestantg  mainline protestantg  1.15 (0.91–1.46)  0.79** (0.67–0.94)  1.08 (0.90–1.31)  model 2  0.96 (0.72–1.27)  1.11 (0.88–1.40)  parental education (1 college)  religious affiliation, w2  1.08 (0.10)  0.80** (0.67–0.94)  college degree/enrolled in college  model 1  parental divorce  table 4 (continued)  1.11 (0.81–1.53)  0.42* (0.21–0.83)  1.08 (0.65–1.80)  1.39 (0.87–2.24)  1.00 (0.76–1.33)  0.72 (0.31–1.68)  1.02 (0.74–1.41)  1.12 (0.86–1.47)  0.79* (0.65–0.96)  1.12 (0.90–1.39)  model 3  1.03 (0.80–1.32)  0.40** (0.23–0.68)  1.12 (0.65–1.96)  1.48 (0.96–2.28)  1.01 (0.81–1.28)  0.90 (0.33–2.45)  0.97 (0.72–1.32)  1.12 (0.88–1.42)  0.79** (0.68–0.93)  1.09 (0.91–1.31)  model 4  0.99 (0.74–1.31)  0.41* (0.22–0.78)  1.04 (0.63–1.72)  1.39 (0.87–2.23)  1.01 (0.78–1.29)  0.82 (0.38–1.76)  0.89 (0.65–1.22)  1.20 (0.93–1.55)  0.78** (0.65–0.93)  1.08 (0.89–1.32)  model 5  4658 journal of religion and health (2022) 61:4635–4673  
  prob. of being in "excellent" health, w3  journal of religion and health (2022) 61:4635–4673  4659  0.29 0.27 0.25 0.23 0.21 0.19 0.17 0.15  consistently religious  lose sbnr  become sbnr  consistently sbnr  changes in religious/spiritual identity, w2-w3 fig. 3 physical health across changes in religious/spiritual identity. 95% confidence intervals displayed. estimates are derived from model 1 of table 3, holding all other covariates at their respective means  models 2–5 of table 4 again introduce each of our four mediating mechanisms. unlike for depression, no mediating variable (attendance, closeness to god, religious doubt, sense of life meaning) reduced the association between being consistently sbnr and mental and physical health to non-significance, nor lowered the size of the odds ratio (or for consistently sbnr 0.67 in model 2, 0.73 in model 3, 0.77 in model 4, and 0.63 in model 5, all associations significant at p 0.01 or lower alpha level). this is inconsistent with the expectations of hypotheses 3–6 for physical health. therefore, because we found no preliminary evidence to support a mediating pathway for physical health, we do not conduct formal mediation analyses for self-rated physical health. supplemental analyses we undertook several additional analyses to examine the limitations of our measure of sbnr identity. first, one lingering question from our findings is whether the results presented above are about stable religiosity or stable non-religiosity. we therefore replicated all analyses by comparing respondents who are not religious and not spiritual (nrns), that is, youth who did not report a belief in god, attendance at religious services, nor a sbnr identity, to those who are stable religious, as well as those who become nrns over time, and those who become religious after reporting a nrns identity. running the same set of main analyses (i.e., without mediation), we found that stable nrns identity was associated with higher depression (b 0.21, p 0.001) and worse physical health (or 0.78, p 0.05) relative to the stably religious. however, individuals who became nrns between waves also reported higher  13  
  4660  journal of religion and health (2022) 61:4635–4673  depression (b 0.16, p 0.01). therefore, compared to the findings for the sbnr, not only was stable non-religiosity associated with lower well-being, but becoming nrns over time was also associated with worse mental health relative to the stable religious group. second, we also undertook analyses which compared the health of the consistently nrns group and the consistently sbnr group. respondents in the consistently sbnr group reported lower depression (b -0.12, p 0.05) than those who were consistently not religious, as well as better physical health (or 1.25, p 0.05). taken together, then, these analyses show that there are meaningful differences between the sbnr and the consistently nrns, suggesting first that the sbnr are distinct from the nsnr in their health profiles, and that our main findings related to transitions in sbnr identity are capturing a unique pattern than what would be offered by a consideration of only non-religiosity on both indicators of health.  discussion a growing number of americans are identifying as “spiritual but not religious” (sbnr), increasing from 19% of the population in 2012 to more than a quarter in 2017 (lipka & gecewicz, 2017). the popularity of the sbnr identity has especially risen among young americans and has doubled in recent decades among this group (chaves, 2011). though the spiritual but not religious are a heterogeneous group (tong & yang, 2018), by their own admission, sbnrs eschew organized religion and prefer to incorporate self-directed approaches to spirituality in their lives (mcclure, 2017; mercadante, 2014). ideologically, it is often thought that the sbnr occupy a space somewhere in between the perceived extremes of those who profess a dogmatic faith and those who adopt a secular, humanistic view of the world (huss, 2014). the objective of the current study was twofold: first, we sought to assess how stable the sbnr identity was as youth experiencing the transition to adulthood. second, we attempted to more firmly locate the sbnr in research on religion and wellbeing and identify how the health of individuals holding a transient or stable sbnr identity compared with those who were consistently religious. once these differences were established, we sought to expand on prior research (baker et al., 2018; walker et al., 2021) and account for any mechanisms that may be driving these varying health profiles of these groups. there were several key results that we derived from our study. first, we found that an sbnr identity was not a stable form of identification as youth transitioned from high school to their college years and beyond. indeed, 22% of our respondents became sbnr over the study period, while 14% of the sample only identified as sbnr at the first time point. in keeping with recent trends of young americans gravitating toward the sbnr identity, the modal category of religious transition was consistently sbnr, representing nearly 40% of the sample, while a quarter of the sample remained consistently religious. these descriptive patterns suggest that while stability in religious identity was observed for more than half of our sample respondents, a fair amount of switching into and out of the sbnr identity appears to  13  
  journal of religion and health (2022) 61:4635–4673  4661  be common among individuals at this early stage of the life course. as we mentioned at the outset, more recently collected data will be needed to determine whether this pattern of change with regards to sbnr identity applies to more recent cohorts of american youth, where being sbnr may be more common. our second and more central study objective assessed how transitions in sbnr identity were associated with health and mental health outcomes. extensive research has examined the connections between religiosity and health, with research tending to suggest that religiosity is associated with more favorable mental and physical well-being (koenig et al., 2012; page et al., 2020). however, it may not necessarily follow that religious individuals have better health than spiritual but not religious individuals, who do not fully identify with institutional religion. a key limitation of most past research on religion and health is that treating non-affiliates as a single group masks important heterogeneity among non-religious identities (baker et al., 2018). with this increasing number of those who report being spiritual but not religious, a better understanding of how this form of non-religious identification should present novel insights to this question. to summarize our main findings, we found for both mental and physical health that only those consistently identifying as sbnr across both time points had lower well-being relative to youth who reported being consistently religious. we also found no observable differences between the consistently religious and those who held a more transient sbnr identity, identifying with this group at only one wave of the study. that significant health differences emerged between those who were consistently sbnr compared to their stably religious counterparts suggests that those who firmly make a commitment to being sbnr at this stage of the life course (by expressing certainty in this identification over time) appear to accumulate important deficits over time compared to those with a firmly cemented religious identity. in other words, becoming sbnr may not be detrimental to health as much as holding firmly to this identity over time. though certainty in one’s (non)-religious convictions is thought to be linked with well-being rather than merely whether one is religious or not, the use of longitudinal data allows us to see that certainty in an sbnr identity seems to be associated with health disadvantage. while ours is the first study, to our knowledge, to explore the health differences between the consistently religious and the sbnr using longitudinal data, an additional innovation of the current study is we tested several mechanisms through which these differences may manifest. this is made possible by the extensive host of religious variables housed in the nsyr data set. we found evidence that three of our four proposed mediators (religious attendance, sense of closeness to god, and religious doubt, but not life meaning) mediated the relationship between being consistently sbnr (compared to the consistently religious) and mental health. beginning first with religious attendance, it is well-known that religious involvement tends to have a salutary association with a wide array of mental health outcomes (schieman et al., 2013). religious involvement may have positive links to health through social support provision, but past research suggests that the sbnr are not disadvantaged in the amount of social connection they accrue (hastings, 2016). despite not lacking in overall connection, the sbnr may not have access to the same social support that consistently affiliated attenders do. as krause (2006)  13  
  4662  journal of religion and health (2022) 61:4635–4673  and others have observed, there might be something distinctive about the support received in a religious community. co-congregants may be especially likely to provide instrumental or emotional support without the expectation of reciprocation. what is more, access to social resources from religious communities can help support individuals as they navigate the often treacherous waters of faith formation. surrounded by like-minded believers, youth who consistently attend religious services may have any doubts or uncertainties about faith quelled through open discussion and have the strength of their worldviews reaffirmed (ozorak, 1989). therefore, relatively speaking, the consistently sbnr might experience mental health deficits from not belonging to a religious community compared to the consistently religious. beyond the social supportive functions served by religious communities, regular and consistent attendance can increase confidence in religious explanations about the world (stark & finke, 2000). one religious cognition that also seems to be of fundamental import to well-being is feelings of closeness to god, higher levels of which are associated with better physical and mental well-being (culver & denton, 2017; proeschold-bell et al., 2014). the entirety of worship services is typically devoted to scriptural readings, sermons, and sometimes also includes sacramental processes that are intended to make believers feel close to god. feelings of greater closeness to god were another reason why the consistently religious reported better mental health than the consistently sbnr. sbnrs are more likely to feel distant from god, perhaps because they reject the moral authority of god or the bible in favor of a more individualistic code of ethics (mcclure, 2017). the finding of the current study can also be interpreted in light of recent research by henderson and kent (2021), who documented a nonlinear relationship between attachment to god (define) and well-being. as these authors find, occupying the middle space of the avoidant/secure attachment to god scale was associated with higher psychological distress than being on either the avoidant or secure end. henderson and kent (2021) argue that the middle of the attachment spectrum is an unsettled position, where believers desire a relational connection with god but fail to perceive it. though measures of attachment to god were not available in the nsyr, it is possible that avoidant attachment to god would precipitate lower feelings of closeness and a form of disengagement from the divine that shares commonalities with those consistently identifying as sbnr. religious doubt was a third mechanism explaining why the consistently sbnr report worse mental health relative to the consistently religious. having doubts about religious questions in life are detrimental to the well-being of both religious and non-religious individuals (ellison & lee, 2010; mercadante, 2014; upenieks, 2021). while it may be commonly assumed that the sbnr are devoid of religious struggles or doubt (mercadante, 2014), these individuals are found to report higher levels of struggle than with respect to whether their worldviews are correct. this pattern was also observed descriptively in the current study, as nearly a quarter of the consistently sbnr reported a high level of doubt in their spiritual beliefs. whether spurred by doubt in the existence of god or by interpersonal conflict with others in their social networks who disapprove of their sbnr identity, the outcome remains the same: grappling with uncertainty about spiritual beliefs is damaging to mental health, and the sbnr are more prone to this type of internal conflict.  13  
  journal of religion and health (2022) 61:4635–4673  4663  it is also important to note that we observed no evidence that a sense of meaning in life was a significant mediating pathway that could account for mental health differences between the consistently sbnr and the consistently religious. some scholars have advanced the argument that humans are hardwired to find meaning in their life (coleman & hood, 2015). a growing body of evidence suggests that the religious unaffiliated do not experience voids in the sense of meaning in life (speed et al., 2018), turning to alternative sources beyond religious beliefs and practices to derive their sense of life meaning (manning, 2013, 2015). the young adults in our sample, especially those in or who possess experience in more secular settings of higher education, likely have a range of alternative meaning sources that they can draw from to derive a sense of life purpose, such as academic, political, leisure or social organizations that they may have become involved with. therefore, on this front, the results of our study suggest that the consistently sbnr are not at a relative disadvantage when it comes to life meaning relative to the consistently religious. despite this fairly consistent evidence of meditation through religious attendance, feelings of closeness to god, and religious doubt, none of our four proposed mediators had a statistically significant indirect effect for explaining differences between the consistently religious and sbnr for physical health. why might this be? ancillary analyses explored additional mediators. for instance, the avoidance of risky health behaviors (e.g., smoking, drinking) are thought to be one reason why the consistently religious would hold an advantage over the sbnr (jang & franzen, 2013). however, the addition of a variable capturing the frequency of engaging in such risky behaviors between waves to not reduce the association between the consistently religious and sbnr to non-significance. while speculative in nature, it is possible that spirituality without formal religiosity may be cognitively similar to processes linked with worse physical health, such as rumination (an ongoing, yet endless search for causes and solutions to internal problems) and loneliness (a sense of detachment or isolation) (e.g., see saunders et al., 2021). both rumination and loneliness have been independently linked to mortality. youth who endorse more spirituality than religiosity could be engaging in a “lonely search” for answers to their ultimate questions, posing a high source of stress, the consequences of which may manifest physiologically and that cannot be explained by any one religious/spiritual indicator alone. finally, it is also worth mentioning that the associations between holding a consistently sbnr identity and health and mental health were not diminished after controlling for religious affiliation. this suggests that although an sbnr identity is negatively associated with religious affiliation, sbnr represents a unique predictor of both health and lack of mental health and is empirically distinct from a lack of religious affiliation. moreover, the hypothesized mechanisms remain salient for depressive symptoms even after adjusting for differences in religious affiliation across transitions in sbnr identity. though additional work remains to be done on this matter, the sbnr identity is present across all religious affiliations (lipka & gecewicz, 2017) (though most common among the religiously unaffiliated and mainline protestants). altogether, however, the sbnr identity is not the province of any one particular religious denomination, so this lack of a contingency here as it relates to health is unsurprising.  13  
  4664  journal of religion and health (2022) 61:4635–4673  limitations and future directions we acknowledge several limitations of our study. first, we only studied young adults in the american context. however, an sbnr identity” is not unique to the american context. there is also a rise in identifying as sbnr in the european context (lindeman et al., 2020). the boundaries of secularity, theism, and religious affiliation may manifest in different ways outside the united states context, and perhaps within the united states, in regions where secularity is less stigmatized (pohls et al., 2020).3 future research should engage in both cross-national comparisons and contextuallevel assessment to improve our understanding of the processes through which religious or sbnr identification impacts health outcomes. second, our sample includes only late teens and early adults, which is far from representative of the sbnr population in the united states. future longitudinal research should continue to assess how religious, sbnr, or irreligious identity unfolds over a broader span of the life course and may impact health and well-being, ideally with more recent data than that employed here as it becomes available. there is some evidence that religion becomes more important with age as the finality of one’s earthly existence tends to occupy a greater place (bengtson et al., 2015) and that older cohorts are more religious than younger ones (hayward & krause, 2013), making the transition to an sbnr identity a more stigmatized and perhaps more health-detrimental transition as individuals grow older. however, older adults may possess more spiritual maturity to handle any uncertainties in their religious or spiritual choices, as “doubts” tend to be less harmful to well-being with age (krause & ellison, 2009). altogether, then, more waves of data are needed to sort out how transitions into and out of an sbnr identity unfold over the life course and in an ever-changing american religious landscape. third, we note that self-descriptions as “spiritual but not religious” as assessed in the nsyr may encompass a range of spiritual experiences (e.g., unwanted exclusion from traditional religious institutions and communities versus a self-initiated exploration of new ideas). such reasons underlying a self-reported sbnr identity may hold potentially different linkages to health. future qualitative work may profitably explore the meanings young adults give to spiritual and religious engagement and how they manifest in the cognitive, emotional, and physiological systems whose operation underlies both mental and physical health outcomes. moreover, qualitative research could help shed light on how respondents perceive what it means to gain or lose an sbnr identity by asking them to reflect on which religious practices/beliefs have become more or less salient.  3  supplemental analyses considered whether respondents’ region of the country (northeast, midwest, south, west) moderated the relationship between change in sbnr identity and physical and mental health. no significant interaction terms were found.  13  
  journal of religion and health (2022) 61:4635–4673  4665  finally, we note that both of our outcome measures, depression and self-rated physical health, were measured with one-item indicators, thereby increasing the chance of measurement error. access to the full ces-d depression scale as well as other mental health scales (e.g., anxiety), would be beneficial, as would the examination of more objective measures of physical health beyond the one considered in the current study.  conclusion while the relationship between religion and health is complex, the addition of the sbnr to the fold and exploring how religious/spiritual identities change over time adds additional nuance to this relationship and is key for advancing research on religion/secularity and health. by differentiating between consistently sbnr and those holding more transient identities, our study reveals significant differences between only the consistently sbnr and the consistently religious. differences in religious attendance, feelings of closeness to god, and religious doubt are related to consequential differences in well-being between these two groups at relatively early stages of the life course. as society changes and religion seems either increasingly irrelevant or simply one lifestyle choice among many, it is possible that the alienation felt by the sbnr might diminish (wilkins‐laflamme, 2016), and so we encourage future researchers to consider the questions we posed here with more recent cohorts of american youth. we have taken one step in this study to identify potential mechanisms underlying such differences, but acknowledging, exploring, and further accounting for these differences can help scholars make important advances in our understanding of the religion/secularity and health relationship moving forward given the constantly evolving religious landscape in the united states and beyond.  appendix see table 5.  13  
  13  0.11  0.15  0.40  many times a year/once a month  2–3 times a month or more  weekly or more  0.10  0.40  0.46  somewhat distant  somewhat close  very close/extremely close  0.30  0.10  0.04  a few doubts  some doubts  many doubts  0.17  0.07  0.12  0.10  0.13  0.23  0.17  never  less than once a month  one to two times a month  about once a week  a few times a week  about once a day  many times a day  private prayer, w2/w3  0.56  no doubts  religious doubt, w2/w3  0.06  extremely distant/very distant  closeness to god, w2/w3  0.33  never attends/a few times a year  religious attendance, w2/w3  0.08  0.14  0.16  0.14  0.19  0.12  0.18  0.06  0.18  0.30  0.46  0.39  0.45  0.12  0.03  0.11  0.20  0.13  0.53  proportion  proportion  0.19  0.19  0.14  0.10  0.10  0.07  0.22  0.02  0.08  0.26  0.64  0.39  0.34  0.14  0.12  0.26  0.15  0.15  0.44  proportion  “somewhat or very true” that one not at all true” that one is is sbnr, nsyr w2 sbnr, nsyr w3  “not at all true” that one is sbnr, nsyr w2  table 5 descriptive statistics across level of agreement of being “spiritual but not religious”  0.11  0.13  0.13  0.12  0.17  0.13  0.21  0.06  0.14  0.29  0.51  0.24  0.34  0.28  0.14  0.08  0.14  0.13  0.64  proportion  “somewhat or very true” that one is sbnr, nsyr w3  4666 journal of religion and health (2022) 61:4635–4673  
  0.42  0.14  0.16  0.09  0.09  0.08  0.01  less than once a month  one to two times a month  about once a week  a few times a week  about once a day  many times a day  0.01  0.04  0.05  0.06  0.15  0.17  0.54  proportion  proportion  0.02  0.07  0.08  0.10  0.14  0.16  0.44  proportion  “somewhat or very true” that one not at all true” that one is is sbnr, nsyr w2 sbnr, nsyr w3  “not at all true” that one is sbnr, nsyr w2  never  bible/scripture reading, w2/w3  table 5 (continued)  0.01  0.03  0.05  0.05  0.13  0.17  0.57  proportion  “somewhat or very true” that one is sbnr, nsyr w3  journal of religion and health (2022) 61:4635–4673 4667  13  
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