Older adults who participate in religious services often report better mental health than those who do not, but the reasons for this benefit have not been fully understood. A new study suggests that the connection is partly explained by an increase in psychological well-being, which acts as a bridge between religious attendance and reduced rates of anxiety and depression. By fostering a sense of purpose and self-acceptance, religious involvement appears to provide a protective buffer against mental distress over time. These findings were published recently in the International Journal of Geriatric Psychiatry.
As the global population ages, mental health challenges among the elderly have become a pressing public health concern. The World Health Organization estimates that a substantial portion of individuals over the age of 60 suffer from mental disorders. Depression and anxiety are particularly common in this demographic. These conditions reduce quality of life and place a heavy strain on families and healthcare systems.
Geriatric researchers have sought to identify factors that might protect against these declines in mental health. Previous investigations have frequently observed a link between attending religious services and lower risks of depression. However, the specific mechanisms driving this relationship remain a subject of inquiry.
Many prior studies focused on social mechanisms to explain this benefit. The prevailing theory has been that religious communities provide social support and a sense of belonging, which helps alleviate loneliness. While social connections are undoubtedly important, they do not account for the entirety of the mental health boost observed in religious attendees.
Zhiya Hua, a researcher at the School of Government at the Shanghai University of Political Science and Law in China, designed a study to look beyond social factors. Hua focused on “psychological well-being” as a potential internal mechanism. This concept differs from the simple absence of illness. It refers to positive mental states, such as having a meaningful purpose in life and feeling a sense of continued personal growth.
The study relied on the framework of psychological well-being developed by psychologist Carol Ryff. This framework includes dimensions such as self-acceptance, autonomy, and environmental mastery. Hua hypothesized that religious attendance might enhance these specific internal resources. If these resources are strengthened, they might subsequently reduce the severity of anxiety and depression.
To test this hypothesis, the researcher utilized data from the National Health and Aging Trends Study (NHATS). This is a large, ongoing survey that tracks a representative sample of Medicare beneficiaries in the United States. The analysis focused on a group of 2,767 older adults who were interviewed annually over a seven-year period, from 2015 to 2021.
The participants had an average age of about 75 years at the beginning of the study. The sample was predominantly female and White, reflecting the demographics of the surviving cohort in this age range. To ensure accuracy, the researcher only included individuals who participated in all seven rounds of interviews.
The study measured three primary variables each year. First, participants were asked a simple yes-or-no question regarding whether they had attended religious services in the past month. Second, they completed a survey designed to measure their psychological well-being. This survey included statements about having purpose, feeling confident, and liking one’s living situation.
Finally, the researcher assessed mental health issues using a standardized screening tool known as the Patient Health Questionnaire for Depression and Anxiety (PHQ-4). This tool asks participants how often they feel down, hopeless, or unable to control worrying. Higher scores on this scale indicate more severe symptoms of mental distress.
Hua employed a statistical method called longitudinal mediation analysis within a Bayesian framework. This advanced approach allows researchers to look at changes over time rather than just a snapshot of a single moment. It helps determine if a change in one variable, like religious attendance, precedes a change in another, like well-being.
The analysis included strict controls for various sociodemographic and health factors. Hua accounted for age, sex, race, education level, and marital status. The study also controlled for physical health conditions, such as the burden of chronic diseases and self-rated health, as well as cognitive function. This was done to ensure that the results were not simply due to healthier people being more able to attend services.
The results showed a clear pattern over the seven-year period. Attending religious services was a strong predictor of improved psychological well-being in subsequent years. Older adults who went to services reported a greater sense of purpose and self-acceptance compared to those who did not attend.
Furthermore, higher levels of psychological well-being were strongly linked to reductions in mental health issues. As participants’ sense of purpose and mastery increased, their reports of depressive symptoms and anxiety decreased. This aligns with broader psychological research suggesting that a meaningful life buffers against emotional distress.
The central finding of the study was the mediation effect. The analysis indicated that psychological well-being served as a partial mediator in the relationship. Specifically, the boost in psychological well-being accounted for 26.7 percent of the total beneficial effect of religious attendance on mental health.
This implies that roughly one-quarter of the mental health advantage gained from going to religious services comes specifically from how it improves a person’s internal outlook and sense of self. The remaining effect is likely due to other factors not measured in this specific model, such as the previously mentioned social support or spiritual comfort.
The study also captured the disruptive impact of the COVID-19 pandemic. The data showed that religious attendance dropped sharply in 2020, likely due to safety restrictions and facility closures. Attendance fell from about 61.5 percent in 2019 to 37.5 percent in 2020. During this same period, scores for mental health issues increased across the sample.
Despite this disruption, the statistical relationship between attendance, well-being, and mental health remained robust when analyzing the full seven-year trajectory. The connection persisted even when accounting for the fluctuations caused by the pandemic.
There are several limitations to this study that warrant consideration. A primary concern is the high rate of attrition. Over the seven years, many original participants dropped out of the survey, mostly due to death or severe illness. The individuals who remained in the study were generally healthier, younger, and had higher cognitive function than those who left.
This creates a potential selection bias. The study may underestimate the challenges faced by older adults with severe health limitations who cannot attend services. The findings apply most directly to the segment of the elderly population that is healthy enough to participate in community activities and annual interviews.
Additionally, the measurement of religious attendance was relatively simple. The survey only asked if the person attended services in the last month. It did not capture the frequency of attendance, private religious practices like prayer, or the depth of personal belief. A more nuanced measure might reveal different patterns.
The scale used to measure psychological well-being was also a shortened version. While valid for broad surveys, it may not capture the full complexity of Ryff’s original framework. Future research using more comprehensive psychological assessments could provide a sharper picture of which specific aspects of well-being are most affected.
The demographic makeup of the sample also limits generalizability. Because the sample was majority White and female, the results may not fully reflect the experiences of men or minority groups. Cultural context plays a large role in how religion is practiced and experienced, so these findings should be tested in more diverse populations.
Finally, while the longitudinal design helps suggest the direction of the effect, it cannot prove causality. It is possible that reverse causality plays a role. People who already have better mental health and a sense of purpose may simply be more motivated to attend religious services.
Despite these caveats, the study offers evidence that religious participation can be a resource for healthy aging. It suggests that the benefits of such participation go beyond social interaction. The rituals, teachings, and community of religious life appear to reinforce an internal sense of value and purpose.
For caregivers and health professionals, these findings imply that supporting religious engagement could be a valid part of mental health care for older adults. Helping elderly individuals overcome barriers to attendance, such as transportation issues, might have positive ripple effects on their psychological state. As Hua concludes in the paper, “supporting older adults who wish to attend religious services may be linked to better psychological well-being and mental health.”
The study, “Religious Attendance, Psychological Well‐Being, and Mental Health Issues Among Older Adults: A Seven‐Year Longitudinal Study in the United States,” was authored by Zhiya Hua.
