Psychiatric patients (age 59+) were assessed before study treatment for major depressive disorder, and again after 3 months. Measures taken before study treatment included facets of religiousness (subjective religiosity, private prayer, worship attendance, and religious media use), social support, and perceived stress. Clinician-rated depression severity was assessed both before and after treatment using the Montgomery-？sberg Depression Rating Scale (MADRS). Structural equation modeling was used to test a path model of direct and indirect effects of religious factors via psychosocial pathways. Subjective religiousness was directly related to worse initial MADRS, but indirectly related to better posttreatment MADRS via the pathway of more private prayer. Worship attendance was directly related to better initial MADRS, and indirectly related to better post-treatment MADRS via pathways of lower stress, more social support, and more private prayer. Private prayer was directly related to better post-treatment MADRS. Religious media use was related to more private prayer, but had no direct relationship with MADRS. 1. Introduction A substantial body of research has linked religiousness with better mental health [1–3], particularly in older adulthood [4–6]. More intensely religious individuals have been found to be at lower risk for depression [7, 8] and, for those who do become depressed, to experience less severe symptoms [9–11] and faster remission [12, 13]. However, the nature of this relationship is complicated by a growing body of contrary findings that religion may be related to worse outcomes in some groups [8, 14], or that in some circumstances there may be a curvilinear relationship, with moderate levels of religiousness conferring the most benefits [9, 15]. Some of these discrepancies may be explained by the complexity of the construct of religion, which entails multiple aspects of belief and behavior such as participation in public worship services, engagement in private prayer, and perceiving order and meaning in one’s life. While these phenomena may be highly correlated, they may also have distinct and even contrasting psychological implications. For example, one recent study of lifetime risk of major depression found that while more frequent attendance at religious services appeared to be a protective factor, reporting a strong relationship with God was associated with more risk of depression [16]. Another study similarly found service attendance linked with lower risk of depression, but stronger self-rated religiousness associated with greater
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