RELIGIOSITY AS CORRELATES OF SOME SELECTED PSYCHOLOGICAL DISORDERS AMONG PSYCHIATRIC OUTPATIENTS IN LAGOS STATE*

This study investigated Religious correlates of some selected Psychological Distress (Depression, Anxiety, Somatization, Paranoid Ideation and Psychotic Disorder) using Psychiatric outpatients in Lagos State Hospital, Lagos. It also examined gender differences in the level of selected psychological distress and religiosity. Analysis of the data gathered through the use of four questionnaires: Biographical Information Questionnaire, SCL-90, Religious Affiliation Scale (RAS) and Religious Trust Scale (RTS) with Pearson's product moment statistics; t-test and one-way Analysis of Variance found that that Somatization (SCL_a), paranoid ideation (SCL_h) and Psychoticism (SCL_i) have positive significant association with RTS, RAS and Religiosity(RAS and RTS) while depression (SCL_d), and anxiety (SCL_e) have negative significant correlation with Religiosity and its two dimensions. In addition, the result of the analysis showed that females obtained higher scores than males in the measures of anxiety, depression, somatisation and paranoid ideation. However, the mean difference is not statistically significant in the measures of anxiety; high Religious group was also found to have lower mean scores than their counterparts with low levels of Religiosity in all the selected measures of psychological distress (i.e. Somatization -SCL_a, depression-SCL_d, anxiety -SCL_e, paranoid ideation -SCL_h and Psychoticism SCL_i). Thus, this finding established that religiosity is associated with improved psychological health, and lower incidence of psychological distress.






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Publication: Ife Psychologia
Author: Ayeni, O B
Date published: March 1, 2011

Introduction

The definition of psychological disorder that was included in DSMIII and DSM-III-R is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. There are many different categories of psychological disorders, and many different facets of human behavior and personality that can become disordered. The different types of psychological disorders includes: anxiety disorders, mood disorders, psychotic disorders, personality disorder etc (WebMD, Inc. 2005).

Psychological disorders have been found to be relatively common, with more than one in three people in most countries reporting sufficient criteria for at least one diagnosis at some point in their life up to the time they were assessed (Pilgrim,et al (2005). A new World Health Organization global survey currently indicates that anxiety disorders are the most common in all but one country, followed by mood disorders in all but two countries, while substance disorders and impulse-control disorders were consistently less prevalent (Gazzaniga, 8c Heatherton, 2006).

In order to find remedy for psychological disorders some authors have investigated factors that either contribute to the incidence or the cure of these disorders. One of such factors is religiosity. It has been found that religious and spiritual issues have an impact on patients' perspectives regarding their health and the management of disorders that afflict them. This is especially true in psychiatry, as feelings of spirituality and religiousness are very prevalent among the psychiatry patients (Philippe 8c Harold, 2009) .According to Kendler et al (2003), Religiosity is a complex, multidimensional construct with substantial associations with lifetime psychopathology. Some dimensions of religiosity are related to reduced risk specifically for internalizing disorders, and others to reduced risk specifically for externalizing disorders, while still others are less specific in their associations. Also, Gleen (1997) found that religion affects mental illness and health in different ways and different aspects of religiosity affect mental health differently. Praying, for instance, may hasten recovery and positively influence healthcare decisions, while religious devotion is associated with greater life satisfaction, improved psychological health and lower incidence of psychological /psychiatric disorders. In the manifestation of psychopathology, religion may be part of it, contributing to the symptoms (obsessions or delusions for example). Sometimes, religion may become rigid and inflexible, and be associated with magical thinking and resistance. When this happens, it may be helpful to integrate the patient into society, or motivate him/her to seek treatment (promoting guilt that motivates treatment). (Isaia, Parker, 8c Murrow, 1999)

Quantitative and qualitative evidence from literature points to a positive and negative (although often modest) relationship between religiosity and mental health in relation to a number of mental health problems.

Chatters et al (2008) in their study on religious correlates of selected measures of lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (depression, substance abuse, generalized anxiety, psychotic symptoms, paranoid ideation, posttraumatic stress, panic disorder) with older African -Americans found that religiosity was significantly and positively associated with the odds of having a lifetime psychiatric disorder.

In some other studies, Bram et al (2004), in their study on the relationship between religiosity and depression in older adults found that extrinsic religiosity was negatively associated with depression. However, Koenig (2007), in his study on the influence of both intrinsic and extrinsic religiosity on depression found that both dimensions of religiosity were variedly associated with depression

Also, Dantas et al (1999), in their systematic study of psychiatric patients on the relationship between psychotic disorders and religiosity found a strong association between psychotic symptoms and religious experiences.

Samra 8c Koch, 2002 and Murray & Lopez, 1996 estimated that the lifetime prevalence of depression ranges from 10% to 25% for women and 5 to 12% for men in their studies on the prevalence of depression; Kroenke and Spitzer, 1998; Nakao et al., 2001; Hiller et al., 2006 also show in their studies on the effect of gender on somatisation symptoms that females generally somatise more than male.

In spite of psychological disorder's effects on morbidity and mortality, only a few studies have examined religiosity and mental disorders that influence changes in psychological state over time in psychiatric outpatients. The role of religion in mental illness remains understudied mostly in Nigeria where religion plays an important part of daily social life. Most prior investigations of this relationship have used measures of religiosity that do not reflect its complexity and/ or have examined the roles of religiosity on psychological well being. Thus, this study examined Religiosity as correlates of some selected measures of lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders (anxiety disorder, psychoticism, major depressive disorder, and paranoid ideation); Also, the following hypothesis were tested: i) there will be gender differences in the level of psychological distress and ii) high religious group will have significantly high scores in measures of the selected psychological distress. The study will also throw more light on the understanding of mental disorders by identifying the religious factors that maintain or sustain it. This will facilitate the designing and planning of a successful treatment programmes for the conditions.

METHODOLOGY

Participants

A total of 50 participants comprising of (25males and 25females) aged 19-48years(Mean=36.30, SD= 8.36) who were psychiatric outpatients from LASUTH were used for this study. The convenience and purposive random sampling techniques were used in selecting the participants.

Instruments

The following tests were used in gathering data:

1. Biographic Information Questionnaire: This consists of 8 items designed to obtain demographic information such as name, sex, age, religion, marital status, ethnic group, file number and doctor diagnosis.

2. Religious Trust Scale (RTS): This is the newly developed instrument for this study. It consists of 26 items designed to measure the level of an individual's intrinsic religiosity (such as communication with God in terms of personal space, faith, hope, trust etc). It yields score on a 5 -point Likert scale response format ranging from 1 to 5. All the items are scored directly; overall score of the individual on RTS is derived by dividing the sum of the total items by 3.

3. Religious Affiliation Scale: This is a questionnaire that was developed by P.F. Omoluabi (1995) to assess the extent to which the individual engages in religious activities, hold strong religious views and believe in prescribed religious practices and religious devotion. It consists of 21 -items that yield scores on a True-False response format. The number of items which the client shaded "True" is multiplied by three to give the client's overall score. The author reported a test-retest reliability coefficient of. 97 in an interval of three weeks and a divergent validity coefficient of -.26.

4. Religiosity measures: this is the addition of overall items in both Religious Trust Scale and Religious Affiliation Scale.

5. Symptom Distress Checklist (SCL -90): This test was developed by Derogatis, Lipman and Covi (1977) to measure several manifestations of psychological distress. The 90-item inventory is designed to assess 10 primary categories of symptoms associated with distress among psychiatric outpatients as well as experience of angiuish arising from the problems of living among people in the general population. The 10 categories are:

A. Somatization: Bodily pain, discomfort and dysfunction.

B. Obsessive -Compulsive: Irresistible thoughts, impulse and action

C. Interpersonal Sensitivity: Discomfort in social situations

D. Depression: Loss of vital energy, interest and motivation

E. Anxiety: Restlessness, nervousness and tension

F. Hostility: Feelings of anger, hatred, repression and unfriendliness.

G. Phobic Anxiety: Irrational fear and avoidance of object, places and situation.

H. Paranoid Ideation: Suspiciousness, distrustfulness and blaming others

I. Psychoticism: Hallucination, delusion and externally manipulated thoughts.

J. Neuroticism: Poor sleep and appetite, feelings of awareness

Out of these 10 categories, subscales D, E, H, I and J were selected for use in this field on the basis of their frequency and incidence in the Nigeria clinical setting (Omoluabi, 2008). The test yields score on a five point Likert response format ranging from o(not at all) to 4 (extremely). The authors reported alpha reliability coefficients, which ranged from .77 for psychoticism to .90 for depression. While one-week interval test-retest reliability coefficients ranged from .78 for hostility to .90 for phobic anxiety. Erinoso (1996) provided the psychometric properties for Nigerian samples. He reported significant coefficients of concurrent validity between Retirement Stress Inventory (Omoluabi,1996) and SCL90 scales, which ranged from .26 for Scale F (Hostility) to .47 for Scale J (Neuroticism).

Procedure

The investigator visited the hospital where the participants were drawn from in advance and obtained permission from the medical director to make use of the psychiatric outpatients. Before granting permission, the Medical Director requested for the study proposal and test instruments for their scrutiny. The investigator was then invited by the ethical committee of the hospital for deliberation on issues ranging from logistics, duration to convenience and ethics. When these issues were resolved, the investigator was given the approval letter and directed to the Head, Psychiatric unit. All the patients' case files were given to the investigator for identification and separation of those patients suffering from the targeted disorders (i.e. anxiety, depression, paranoid ideation and psychoticism). The assessment was conducted in groups. The participants were randomly selected and taken to the ward, which accommodated all of them conveniently in each clinic day. The patients were briefed and the instruments were administered after establishing rapport. Each of the participants was given the instruments to fill. They were encouraged to ask questions or clarification where necessary. No time limit was given for the completion of the test instrument. The filled instruments were collected for scoring using the scoring manual for each of the instruments.

The Statistical Package for the Social Sciences (SPSS) was used for analysis of the data after collection and scoring. The following statistics were employed for the analysis: t-independent test, Pearson product moment correlation, one-way ANOVA, apart from computing mean scores, standard deviations and age ranges.

Results

In order to identify the Religious factors associated with the selected DSM IV mental disorder (that is Somatization, Depression, Anxiety, Paranoid Ideation and Psychoticism), the participants' score on Religious Trust Scale (RTS) and Religious Affiliation Scale (RAS) were added together to obtain their score on Religiosity. Pearson Product moment Correlation was computed to correlate their score on Religiosity with score on the five measures of psychological distress. The result is presented in Table 1

The result shows that RTS, RAS, and Religiosity have positive significant relationships with SCL_a, SCL_h, 8c SCL_i (Somatization, Paranoid Ideation and Psychoticism). They also have significant negative relationship with SCL_d and SCL_e (Depression and Anxiety)

In order to determine the measures which best predict religiosity, multiple regression analysis was computed with Religiosity as the criterion variable. The result is presented in Table 2.

The result above shows that all the measures accounted for 15% of the variance in religiosity.

In order to find out if the contribution of the measures is significant, ANOVA of multiple regressions was computed. The result is presented in Table 3

In order to determine the influence of gender on the manifestation of anxiety, depression, somatisation, paranoid ideation and psychoticism, the mean and standard deviation of the scores of both male and female participants in all the measures of the selected mental disorders were computed. Also computed was independent t statistics to determine the level of significance of the observations. The result is presented in Table 4.

The results above show that females had higher mean scores in measures of anxiety, depression, somatization and Paranoid Ideation and the differences in mean are statistically significant except in measure of anxiety. This result partially confirm hypothesis 2 which predicted a significant gender difference in the level of mental disorder.

In order to determine the psychopathological manifestations of religiosity, the scores of all the participants in both RTS and RAS were added together to give the score of Religiosity which was rank ordered in ascending order of magnitude. The list was divided into two groups of low (that is those scores below the given norms in both RAS and RTS manuals) and high ((that is those scores above the given norms in both RAS and RTS manuals) levels of religiosity. The scores of members of the two religious groups (low and high) in 5 of the subscales of SCL-90 were identified. Their means and standard deviations were computed. The result is presented in Table 5.

The result above shows that the low religious group had the highest mean scores in all the measures of SCL-90 except in measure of somatisation indicating that the low religious group has more level of depression, anxiety, paranoid ideation and psychoticism than high religious group. They also had higher standard deviation in all the measures except in somatization and depression.

In order to determine if the observed difference in the table above are statistically significant, one-way ANOVA was computed. The result is presented in table 6.

The result above showed that the observed differences in the measures of the psychological distress were statistically significant,

Discussion

Several psychological factors have been associated with religiosity but studies have not shown the extent to which they predict it. The results in Table 1 showed that Somatization (SCL_a), paranoid ideation (SCL_h) and Psychoticism (SCL_i) have positive significant association with RTS, RAS and Religiosity while depression (SCL_d), and anxiety (SCL_e) have negative significant correlation with Religiosity and its two dimensions. However, using these measures to predict religiosity, Tables 2 and 3 showed that using the "enter" method, a significant regression model emerged: F (5, 44) = 3.50, at P<.05. The model explained 55% of the variance (R2 = .55) thereby confirming hypothesis 1 which state that there will be significant relationship between religiosity and the selected psychological distress.

This result is in agreement with the view in related studies. Chatters et al (2008) in their study on religious correlates of selected measures of lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (depression, substance abuse, generalized anxiety, psychotic symptoms, paranoid ideation, posttraumatic stress, panic disorder) with older African -Americans found that religiosity was significantly and positively associated with the odds of having a lifetime psychiatric disorder.

In some other studies, Bram et al (2004), in their study on the relationship between religiosity and depression in older adults found that extrinsic religiosity was negatively associated with depression. This is in line with the result of this study that showed that there is a negative correlation between RAS and Depression. However, Koenig (2007), in his study on the influence of both intrinsic and extrinsic religiosity on depression found that both dimensions of religiosity were variedly associated with depression

Also, Dantas et al (1999), in their systematic study of psychiatric patients on the relationship between psychotic disorders and religiosity found a strong association between psychotic symptoms and religious experiences.

It is worth noting that to the knowledge of this researcher no study has examined the relationship between religiosity and somatisation

The result in Table 4 demonstrated the influence of gender on the selected psychological distress. It showed that females obtained higher scores than males in the measures of anxiety, depression, somatisation and paranoid ideation. However, the mean difference is not significant in the measures of anxiety as shown by the tvalues. This partially confirms Hypothesis 2 that predicted gender differences in each of the psychological distress. The implication of this result is that depression, somatisation and paranoid ideation are higher in females than males.

This result is in line with many empirical body of evidence. Samra 8c Koch, 2002 and Murray & Lopez, 1996 estimated that the lifetime prevalence of depression ranges from 10% to 25% for women an 5 to 12% for men in their studies on the prevalence of depression; Kroenke and Spitzer, 1998; Nakao et al., 2001; Hiller et al., 2006 also show in their studies on the effect of gender on somatisation symptoms that females generally somatise more than male.

The results in Tables 5 & 6 were to determine the pattern of psychological distress that characterizes the two levels of Religiosity. They showed that those high in Religiosity had lower mean scores than their counterparts with low levels of Religiosity in all the selected measures of psychological distress (i.e. Somatization -SCL_a, depression-SCL_d, anxiety -SCL_e, paranoid ideation -SCL_h and Psychoticism SCL_i). The mean differences were significant. Hypothesis 3 which state that high religious group will have significantly high scores in measures of the selected psychological distress is therefore rejected. The implication of this is that the level of depression, anxiety, somatisation, paranoid ideation and psychoticism are lower in high religious group than the low religious group. This is consistent with the findings of Gleen (1997) who found that religiosity is associated with greater life satisfaction, improved psychological health and lower incidence of psychological distress. Also, Roff et al, (2004) and Husaini (2003) found that highly religious individuals have lower levels of psychological distress. This result indicates that religiosity has a protective effect against the development of psychological distress.

* E-mail: yayeni2002@yahoo.com

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Author affiliation:

Ayeni O.B., Ayenibiowo K.O. & Ayeni E.A.

Department of Psychology

University of Lagos

Akoka, Lagos.

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