Showing papers on "Mental health published in 1991"
TL;DR: TheMHI-5 was as good as the MHI-18 and the GHQ-30, and better than the SSI-28, for detecting most significant DIS disorders, including major depression, affective disorders generally, and anxiety disorders.
Abstract: We compared the screening accuracy of a short, five-item version of the Mental Health Inventory (MHI-5) with that of the 18-item MHI, the 30-item version of the General Health Questionnaire (GHQ-30), and a 28-item Somatic Symptom Inventory (SSI-28). Subjects were newly enrolled members of a health maintenance organization (HMO), and the criterion diagnoses were those found through use of the Diagnostic Interview Schedule (DIS) in a stratified sample of respondents to an initial, mailed GHQ. To compare questionnaires, we used receiver operating characteristic analysis, comparing areas under curves through the method of Hanley and McNeil. The MHI-5 was as good as the MHI-18 and the GHQ-30, and better than the SSI-28, for detecting most significant DIS disorders, including major depression, affective disorders generally, and anxiety disorders. Areas under curve for the MHI-5 ranged from 0.739 (for anxiety disorders) to 0.892 (for major depression). Single items from the MHI also performed well. In this population, short screening questionnaires, and even single items, may detect the majority of people with DIS disorders while incurring acceptably low false-positive rates. Perhaps such extremely short questionnaires could more commonly reach use in actual practice than the longer versions have so far, permitting earlier assessment and more appropriate treatment of psychiatrically troubled patients in primary care settings.
1,457 citations
TL;DR: Smith as discussed by the authors argues that sociologists generate idology instead of knowledge, particularly where women are concerned, and argues that idology affects methods of inquiry and transforms what actually happens in people's lives into a formalized picture that lacks subjectiveness.
Abstract: Sociologists generate idology instead of knowledge - particularly where women are concerned. By starting with the theoretical formulations of their discipline and then interpreting people's activities as expressions of those ideas, sociologists both participate in and perpetuate society's traditional power relations.So argues Dorothy E. Smith in this provocative study of her own discipline and its relationship to women's lives.While acknowledging that social science is ideological, Smith argues that for sociologists idology affects methods of inquiry and transforms what actually happens in people's lives into a formalized picture that lacks subjectiveness. She explicates the need for an alternative sociology that better explores everyday experience, suggesting a Marxist materialist ideology, and emphasizing that ideology is not content but practice.Smith is especially concerned with the application of sociological ideology to the human service bureaucracy and the way institutions of mental health reconstruct women's lives. She provides meticulous accounts of the ways in with police reports, governments statistics, hospital records, and psychiatric files and ideologically interpreted, transforming a person's life history in the process. In a reveatory chapter on biographer Quentin Bell's exploration of Virginia Woolf's suicide, Smith demonstrates once again how the professional who claims to report an event acurrately also shapes it.Highly critical of current sociological practice, she also hopes that alternative appraoches will change the discipline.
1,202 citations
980 citations
TL;DR: Depression findings of more negative affect in women do not conflict with well-being findings of equal happiness across gender, and generally, women's more intense positive emotions balance their higher negative affect.
Abstract: Affect intensity (AI) may reconcile 2 seemingly paradoxical findings: Women report more negative affect than men but equal happiness as men. AI describes people's varying response intensity to identical emotional stimuli. A college sample of 66 women and 34 men was assessed on both positive and negative affect using 4 measurement methods: self-report, peer report, daily report, and memory performance. A principal-components analysis revealed an affect balance component and an AI component. Multimeasure affect balance and AI scores were created, and t tests were computed that showed women to be as happy as and more intense than men. Gender accounted for less than 1% of the variance in happiness but over 13% in AI. Thus, depression findings of more negative affect in women do not conflict with well-being findings of equal happiness across gender. Generally, women's more intense positive emotions balance their higher negative affect.
808 citations
TL;DR: In this paper, the authors investigated services received, length of treatment, and outcomes of thousands of Asian-American, African-Americans, Mexican-Americans and White clients using outpatient services in the Los Angeles County mental health system.
Abstract: This study investigated services received, length of treatment, and outcomes of thousands of Asian-American, African-American, Mexican-American, and White clients using outpatient services in the Los Angeles County mental health system. It tested the hypothesis that therapist-client matches in ethnicity and language are beneficial to clients. Results indicate that Asian Americans and Mexican Americans underutilized, whereas African Americans overutilized, services. African Americans also exhibited less positive treatment outcomes. Furthermore, ethnic match was related to length of treatment for all groups. It was associated with treatment outcomes for Mexican Americans. Among clients who did not speak English as a primary language, ethnic and language match was a predictor of length and outcome of treatment. Thus, the cultural responsiveness hypothesis was partially supported.
793 citations
TL;DR: The developmental pattern of depressed affect is examined over early and middle adolescence, with a special focus on the patterns of boys as compared to girls, and a developmental model for mental health in adolescence is tested for its power in explaining the emergence of gender differences in depression.
Abstract: Although there has been evidence for some time of a sex difference in depression, relatively little research has examined the developmental process by which women come to be at greater risk than men for depression. In this paper, the developmental pattern of depressed affect is examined over early and middle adolescence, with a special focus on the patterns of boys as compared to girls. In addition, a developmental model for mental health in adolescence is tested for its power in explaining the emergence of gender differences in depression. Longitudinal data on 335 adolescents randomly selected from two school districts were used to test the hypotheses. Results revealed that girls are at risk for developing depressed affect by 12th grade because they experienced more challenges in early adolescence than did boys. The sex difference in depressed affect at 12th grade disappears once early adolescent challenges are considered.
698 citations
TL;DR: Results provide somewhat stronger evidence for an activity-depression link than do previous studies, and argue for the inclusion of exercise programs as part of community mental health programs, as well as for further studies that focus on the relation between life-style and mental health.
Abstract: The relation between level of physical activity and risk of subsequent depression was examined using three waves of data from the Alameda County Study. Among subjects who were not depressed at baseline, those who reported a low activity level were at significantly greater risk for depression at the 1974 follow-up than were those who reported high levels of activity at baseline. Adjustments for physical health, socioeconomic status, life events, social supports, and other health habits did not affect the association appreciably. Associations between 1965-1974 changes in activity level and depression in the 1983 follow-up suggest that the risk of depression can be altered by changes in exercise habits, although these associations were not statistically significant after adjustment for covariates. These results provide somewhat stronger evidence for an activity-depression link than do previous studies, and they argue for the inclusion of exercise programs as part of community mental health programs, as well as for further studies that focus on the relation between life-style and mental health.
647 citations
TL;DR: Limited support was found for the hypothesis that the positive and negative aspects of caregiving contributed to analogous aspects of generalized psychological well-being but not to the opposite-valence outcomes.
Abstract: Groups of spouse (N = 285) and adult child (N = 244) caregivers of elderly parents suffering from Alzheimer's disease were interviewed regarding their caregiving behaviors, evaluations of caregiving, and general psychological well-being. A model of caregiving dynamics where the objective stressor, caregiver resources, and subjective appraisal of caregiving (operationalized as caregiving satisfaction and burden) were studied as they affected both positive affect and depression was tested. For spouses, caregiving satisfaction was not related to aspects of the stressor, but was a significant determinant of positive affect. Among adult children, high levels of caregiving behavior resulted in both greater caregiving satisfaction and burden. Burden, in turn, was related to depression in both groups but, among adult child caregivers, positive affect was not affected by caregiving satisfaction. Limited support was found for the hypothesis that the positive and negative aspects of caregiving contributed to analogous aspects of generalized psychological well-being but not to the opposite-valence outcomes.
616 citations
TL;DR: Research suggesting that refugees are an at-risk population, making them especially suitable for public health interventions, is summarized, given its importance to prevention in refugee mental health.
Abstract: Primary prevention in refugee mental health requires information from clinical, health, and cross-cultural psychology. Primary prevention's roots are in public health, which is distinguished by a communitywide perspective for addressing mental health concerns. This article summarizes research suggesting that refugees are an at-risk population, making them especially suitable for public health interventions. Research on stress and acculturation is highlighted, given its importance to prevention in refugee mental health. The opportunities for primary prevention programs and policies at 3 levels (i.e., local community, national, and international) are illustrated with case examples from both the United States and Canada. Prevention at the international level is highlighted by a World Health Organization Mental Health Mission to camps on the Thai-Cambodian border.
615 citations
TL;DR: A sociological model for mental health consequences of social organization is distinguished from a sociomedical model for the social etiology of particular disorders as discussed by the authors, which uses stress to explain associations between social placement and disorder.
Abstract: A sociological model for the mental health consequences of social organization is distinguished from a sociomedical model for the social etiology of particular disorders. Both models use stress to explain associations between social placement and disorder. These models are not interchangeable, despite apparent similarities, but researchers frequently apply the sociomedical model to sociological questions. Discrepancies between models are illustrated with survey data collected from a community sample of adults. We demonstrate that gender differences in the impact of stress are disorder-specific and do not indicate general differences between women and men in susceptibility to stress.
610 citations
Book•
01 Jan 1991
TL;DR: Physical Activity and Psychological Well-being as mentioned in this paper represents a research consensus on the relationship between physical activity and aspects of mental health, providing an overview of the case for the role of exercise in the promotion of psychological well-being.
Abstract: The 'feel-good' effect of physical activity is widely reported among participants. Physical Activity and Psychological Well-Being represents a research consensus on the relationship between physical activity and aspects of mental health, providing an overview of the case for the role of exercise in the promotion of psychological well-being. Topics covered include: * anxiety and stress * depression * mood and emotion * self-perceptions and self-esteem * cognitive functioning and ageing * psychological dysfunction This book is invaluable reading for students and researchers working in the exercise, sport and health sciences, and for health and clinical psychologists. It is also a foundation text for health promotion and health service professionals, particularly those working in the area of mental health.
TL;DR: The comparison of present and ideal self-ratings supported the hypothesis that with age, individuals achieve a closer fit between their ideal and their actual self-perceptions.
Abstract: Young, middle-aged, and elderly adults (N = 308) evaluated themselves on 6 dimensions of psychological well-being according to present, past, future, and ideal self-assessments. Young and middle-aged adults saw considerable improvement in themselves from the past to the present on all dimensions of well-being. The elderly, however, indicated largely a perception of stability with prior levels of functioning. Future ratings showed that the 2 younger groups expected continued gains in the years ahead, whereas the oldest respondents foresaw decline on most aspects of well-being. The comparison of present and ideal self-ratings supported (cross-sectionally) the hypothesis that with age, individuals achieve a closer fit between their ideal and their actual self-perceptions.
Posted Content•
TL;DR: The sociological study of the mental health of racial-ethnic minorities addresses issues of core theoretical and empirical concern to the discipline as mentioned in this paper, and identifies conceptual and methodological problems that continue to confront research in this field.
Abstract: The sociological study of the mental health of racial-ethnic minorities addresses issues of core theoretical and empirical concern to the discipline. This review summarizes current knowledge about minority mental health and identifies conceptual and methodological problems that continue to confront research in this field. First, a critique is presented of epidemiological approaches to the definition and measurement of mental health in general, and minority mental health in particular, including an overview of the most frequently used symptom scales and diagnostic protocols. Next, the most important research studies conducted over the past two decades are summarized and discussed, and comparisons of prevalence rates and correlates of depressive symptomatology among Black, Hispanic, Asian, and American Indian ethnic groups are provided. Following the overview of descriptive epidemiological findings, some key analytic issues surrounding the study of stress, adaptation and minority mental health are considered. Finally, we propose various recommendations for future research.
TL;DR: The sociological study of the mental health of racial-ethnic minorities addresses issues of core theoretical and empirical concern to the discipline as discussed by the authors, and identifies conceptual and methodological problems that continue to confront research in this field.
Abstract: The sociological study of the mental health of racial-ethnic minorities addresses issues of core theoretical and empirical concern to the discipline. This review summarizes current knowledge about minority mental health and identifies conceptual and methodological problems that continue to confront research in this field. First, a critique is presented of epidemiological approaches to the definition and measurement of mental health in general, and minority mental health in particular, including an overview of the most frequently used symptom scales and diagnostic protocols. Next, the most important research studies conducted over the past two decades are summarized and discussed, and comparisons of prevalence rates and correlates of depressive symptomatology among Black, Hispanic, Asian, and American Indian ethnic groups are provided. Following the overview of descriptive
TL;DR: This paper found that most studies linking religious commitment to psychopathology have employed mental health measures that they have called "soft variables" that attempt to measure theoretical constructs, whereas most of the research linking religion to positive mental health is on hard variables, that is, real life behavioral events which can be reliably ob-served and measured and which are unambiguous in their significance.
Abstract: Research on the relationship between religious commitment and psychopamology has produced mixed findings. In a recent meta-analysis, Bergin (1983) found mat 23% of the studies reported a negative relationship, 47% reported a positive relationship, and 30% reported no relationship at all between religion and mental health. Based on our review of more than 200 studies, we have discovered four additional trends: (a) Most studies linking religious commitment to psychopathology have employed mental health measures that we have called “soft variables,” that is, paper-and-pencil personality tests which attempt to measure theoretical constructs. In contrast, most of the research linking religion to positive mental health is on “hard variables,” that is, “real life” behavioral events which can be reliably ob-served and measured and which are unambiguous in their significance. (b) Low levels of religiosity are most often associated with disorders related to undercontrol of impulses, whereas high levels of religiosi...
Book•
01 Jan 1991
TL;DR: Part 1 Theory and tradition: Race, culture and ethnicity racism western psychiatry mental health and mental disorder and practice and innovation: applied psychiatry different forms of psychiatry technologies for mental health mental health for all.
Abstract: Part 1 Theory and tradition: Race, culture and ethnicity racism western psychiatry mental health and mental disorder Part 2 Practice and innovation: applied psychiatry different forms of psychiatry technologies for mental health mental health for all
TL;DR: Factors that may contribute to the observed gender differences in the social support-physical health relationship are discussed and future research should include adequate numbers of women and more sophisticated measures of social support to move the field forward.
Abstract: A large body of prospective data has accumulated linking social support to health, and most social scientists agree that low levels of support are associated with poor physical and mental health. Unfortunately, most of the research has been limited to White men. When women and people of color are included in the designs, the relationships between social support and physical health are more complicated. Prospective population-based studies provide evidence that low support is associated with increased risk of mortality in women. However, in several studies, results indicated that, for specific age groups, women with high social support have increased risk of mortality. Factors that may contribute to the observed gender differences in the social support-physical health relationship are discussed. Future research should include adequate numbers of women and more sophisticated measures of social support to move the field forward.
TL;DR: Current research on the prevalence of alcohol, drug, and mental (ADM) disorders and the characteristics of homeless substance abusers and persons with mental illness and methodological problems in homelessness research are reviewed.
Abstract: This article describes recent research on the prevalence of alcohol, drug, and mental (ADM) disorders and the characteristics of homeless substance abusers and persons with mental illness. Methodological problems in homelessness research are reviewed, particularly in relation to definitions of homelessness and sampling- and case-ascertainment methods. Prevalence rates of ADM disorders are much higher in homeless groups than in the general population. As is true of homeless people in general, homeless substance abusers and mentally ill persons are characterized by extreme poverty; underutilization of public entitlements; isolation from family, friends, and other support networks; frequent contact with correctional agencies; and poor general health. Knowledge of these disadvantages should be used to advocate for better services to prevent homelessness and support homeless people.
TL;DR: Functional somatic symptoms appear to be common expressions of distress instead of defenses against awareness, and patterns of response do not support a dissociation between physical and emotional symptoms.
Abstract: Objective: Somatization has often been viewed as a defense against awareness of emotional distress or as a masked version ofdepression. This report examines whether community residents with high levels offunctional somatic symptoms also report overt psychological distress and whether somatization is associated with any specific psychiatric disorder. Method: Analyses used data from the community sample of the National Institute of Mental Health Epidemiologic Catchment Area (ECA) study, a population-based survey ofpsychiatric morbidity among more than 1 8,000 residents of five U.S. communities. Results: Increasing number of somatization symptoms was strongly associated with overt expression of psychological distress and psychiatric symptoms. Among ECA respondents with five or more current functional somatic symptoms, 63% reported current psychological symptoms and 50% met criteria for a current psychiatric diagnosis (compared to 7% and 6%, respectively, among those with no current somatization symptoms). Somatization symptoms showed strongest associations with anxiety and depressive symptoms, intermediate association with symptoms ofpsychotic disorders, and weakest associations with symptoms ofsubstance abuse and antisocial personality. Conclusions: ECA study respondents with high levels ofsomatization symptoms typically reported overt psychological distress, especially anxiety and depression. Patterns of response do not support a dissociation between physical and emotional symptoms. Functional somatic symptoms appear to be common expressions of distress instead of defenses against awareness. (Am J Psychiatry 1991; 148:1494-1500)
TL;DR: A decade of work by Bergin and others is reviewed and synthesized concerning two broad issues: (a) the role of values in psychotherapy and (b) the relation of religion to mental health as mentioned in this paper.
Abstract: A decade of work by Bergin and others is reviewed and synthesized concerning two broad issues: (a) the role of values in psychotherapy and (b) the relation of religion to mental health. Trends have changed and there is now more professional support for addressing values issues in treatment. There is also more openness to the healthy potentialities of religious involvement, and therapists themselves manifest a new level of personal interest in such matters. Cautions and guidelines for dealing with such issues are considered in both empirical and clinical terms. The multifactorial nature of religion is documented, and healthy and unhealthy ways of being religious are described. Suggestions are given for including education in values and religious issues in the training of clinicians so that the vast population of religious clientele may be better served.
TL;DR: Among patients who met Bedford College criteria, mean episode durations were longer for anxiety disorders than for depressive disorders, but among the new patients, those with psychiatric disorders recognized by the GP were more likely to receive mental health interventions.
Abstract: • This article addresses the issues of recognition of psychiatric disorders by general physicians (GPs) and the effects of recognition on management and course. Among 1994 patients who were screened with the General Health Questionnaire and who were rated by their GP, 1450 (72.7%) had not been identified by the GP as having a psychiatric disorder in the year before the index visit. Among these "new" patients, 557 (38.4%) had positive General Health Questionnaire scores. Only 47% of the new patients who met Bedford College diagnostic criteria for anxiety, depression, or illdefined disorder had their psychiatric disorder recognized by their GP. Among patients who met Bedford College criteria, mean episode durations were longer for anxiety disorders (20 to 22 months) than for depressive disorders (9 to 10 months). Among the new patients, those with psychiatric disorders recognized by the GP were more likely to receive mental health interventions. Recognition was associated with shorter episode duration among patients with an anxiety disorder, but not among patients with depressive or illdefined disorders.
Book•
01 Aug 1991
TL;DR: In this paper, the authors describe the "embodiments of mind" of the Raindancer, Scout, and Talking Chief, and their cohorts in the early 60's.
Abstract: Midcentury, USA March 8-9 1946 describing "embodiments of mind" - McCulloch and his cohorts Raindancer, Scout and Talking Chief logic clarifying and logic obscuring problems of deranged minds, artists and psychiatrists the Macy Foundation and worldwide mental health Lazarsfield, Lewin and political conditions gestalten go to bits 1. - from Lewin to Bavelas gestalten go to bits 2. - Kohler's visit metaphor and synthesis then and now. Appendix: members of the cybernetics group.
TL;DR: Results did not differ for men and women, and effects of social support, depression, and major life events on the incidence of daily hassles remained significant without the inclusion ofHassles reflecting depressive symptomatology or problems in relationships or whose content overlapped with majorLife events.
Abstract: Effects of social support, negative life events, and daily hassles on depressive symptoms were assessed in 301 adults aged 65 or older, in person 3 times at 6-month intervals and by mail questionnaires every month over a 12-month period. Initial social support predicted severity of depressive symptoms 12 months later. Social support and initial levels of depressive symptomatology predicted number of daily hassles but not number of major life events. Effects of social support, depression, and major life events on the incidence of daily hassles remained significant without the inclusion of hassles reflecting depressive symptomatology or problems in relationships or whose content overlapped with major life events. Daily hassles mediated the effects of major life events on subsequent depression. Results did not differ for men and women. Implications for models of the relations among social support, stress, and depression are discussed. In a substantial body of literature that has accumulated over the past 15 years, researchers have evaluated the relations among social support, stressful life events, and physical and mental health status. Two models of these relations have been proposed. According to the first, the buffering hypothesis, social support serves a protective role primarily during times of stress by enhancing adaptive coping behavior (Cobb, 1979). Thus an interaction is hypothesized between stress and social support in predicting physical and mental health, whereby the effect of stress on health-related variables varies depending on the level of social support. According to the second model, social support has positive effects on health and well-being in both the presence and the absence of stress. This direct effects model predicts that there is a positive relation between social support and physical and mental health that is independent of the effects of stress. Empirical research on the relations among stress, social support, and health has provided mixed support for the buffering hypothesis (for a recent review, see S. Cohen & Wills, 1985). Although some researchers have found that high levels of social support protect a person from the negative effects of high levels of stress, others have found that supportive relationships are associated with good physical and mental health regardless of the presence or absence of stress. In a relatively small number of studies, investigators have examined the effects of social support and stressful life events
TL;DR: Higher socioeconomic status women spent significantly more time each week in leisure-timePhysical activity, job-related physical activity, and household physical activity than did lower socioeconomic statusWomen, and higher socioeconomic status men tended to be more active in leisure -time physical activity.
Abstract: Few data on physical activity habits among populations of low socioeconomic status have been published. The authors studied physical activity habits--leisure-time physical activity, job-related physical activity, household physical activity, and walking--among 172 lower socioeconomic status women and 84 lower socioeconomic status men and compared their habits with those of 208 higher socioeconomic status women and 95 higher socioeconomic status men. All subjects resided in the greater Pittsburgh, Pennsylvania, area. Data collection occurred throughout 1986. Lower socioeconomic status women, the least active group, averaged 1,536 +/- 1,701 minutes/week (+/- standard deviation) of total physical activity, whereas higher socioeconomic status women, the most active group, averaged 2,079 +/- 1,807 minutes/week (p less than 0.0001). Higher socioeconomic status men averaged 1,952 +/- 1,799 minutes/week, and lower socioeconomic status men averaged 1,948 +/- 1,916 minutes/week. Higher socioeconomic status women spent significantly more time each week in leisure-time physical activity, job-related physical activity, and household physical activity than did lower socioeconomic status women. Lower socioeconomic status men spent significantly more time each week walking and doing household chores, whereas higher socioeconomic status men tended to be more active in leisure-time physical activity. These data suggest important quantitative and qualitative differences in physical activity among population subgroups. In view of the important role of physical activity in promoting physical and mental health, reasons for the differences among groups of varying socioeconomic status must be examined and elucidated.
TL;DR: Examining changes in mental health care between 1940 and 1970, Grob shows that community psychiatric and psychological services grew rapidly, while new treatments enabled many patients to lead normal lives.
Abstract: The distinguished historian of medicine Gerald Grob analyzes the post- World War II policy shift that moved many severely mentally ill patients from large state hospitals to nursing homes, families, and subsidized hotel rooms--and also, most disastrously, to the streets. On the eve of the war, public mental hospitals were the chief element in the American mental health system. Responsible for providing both treatment and care and supported by major portions of state budgets, they employed more than two-thirds of the members of the American Psychiatric Association and cared for nearly 98 percent of all institutionalized patients. This study shows how the consensus for such a program vanished, creating social problems that tragically intensified the sometimes unavoidable devastation of mental illness. Examining changes in mental health care between 1940 and 1970, Grob shows that community psychiatric and psychological services grew rapidly, while new treatments enabled many patients to lead normal lives. Acute services for the severely ill were expanded, and public hospitals, relieved of caring for large numbers of chronic or aged patients, developed into more active treatment centers. But since the main goal of the new policies was to serve a broad population, many of the most seriously ill were set adrift without even the basic necessities of life. By revealing the sources of the euphemistically designated policy of "community care, " Grob points to sorely needed alternatives.
TL;DR: Results of Pearson correlation analysis and matrix analysis of data supported a relationship between self-transcendence and mental health found in previous research, thus demonstrating the importance of the expansion of self boundaries in older adults.
Abstract: Patterns of self-transcendence that older adults report as being important to their emotional well-being are described in this study, and the relationship between self-transcendence and mental health symptomatology in oldest-old adults is investigated. The sample consisted of 55 independent-living older adults, 80 to 97 years old. Methodological trianglulation was used whereby qualitative data together with quantitative findings were examined. Four patterns of self-transcendence, congruent with the investigator's definition, were identified by the participants as being important to their sense of well-being: Generativity, Introjectivity, Temporal Integration, and Body-Transcendence. Results of Pearson correlation analysis and matrix analysis of data supported a relationship between self-transcendence and mental health found in previous research, thus demonstrating the importance of the expansion of self boundaries in older adults.
TL;DR: Although religious attendance does not directly reduce psychological distress, it buffers the deleterious effects of stress on mental health and in the face of stressful events and physical health problems, religious attendance reduces the adverse consequences of these stressors on psychological well-being.