title: Spiritual belief, social support, physical functioning and depression among older people in Bulgaria and Romania.
abstract: OBJECTIVE
  An exploratory investigation is reported into the role of spirituality and religious practice in protecting against depression among older people living in rural villages in Bulgaria and Romania, two neighbouring countries with similar cultural, political and religious histories, but with differing levels of current religiosity.
  
  
  METHODS
  In both countries, interviews were conducted with samples of 160 persons of 60 years and over in villages of similar socio-economic status. The Hospital Anxiety and Depression-D scale and the Royal Free Interview for Religious and Spiritual Beliefs were used to assess depression and spiritual belief and practice respectively. In addition social support, physical functioning and the presence of chronic diseases were assessed. One year later, follow-up interviews were conducted with 58 of the original sample in Bulgaria, in which additional measures of depression and of spiritual belief and practice were also included.
  
  
  RESULTS
  The study demonstrates, as expected, significantly lower levels of spiritual belief in the Bulgarian sample (Bulgarian mean 29.7 (SD = 19.1), Romanian mean 47.6 (SD = 11.2), t = 10.2, p < 0.001), as well as significantly higher levels of depression (Bulgarian mean 12.0 (SD = 4.9), Romanian mean 7.3 (SD = 4.1), t = 9.3, p < 0.001), the latter attributable in large part to higher morbidity and disability rates, but less evidently to differences in strength of belief. However, analyses from both the cross-sectional study and the one-year follow-up of the Bulgarian sample do suggest that spiritual belief and practice may both influence and reflect physical and mental illness.
  
  
  CONCLUSIONS
  Much of Eastern Europe displays high rates of depression among its older population and provides opportunities for investigation of the role of religious belief and practice in preventing and coping with depression. Further research is encouraged in populations of diverse religiosity.
authors.affiliation: Faculty of Medicine, Health and Life Sciences, University of Southampton, Southampton, England, UK. p.g.coleman@soton.ac.uk
authors.forename: Peter G
authors.initials: PG
authors.lastname: Coleman
authors.forename: Roxana O
authors.initials: RO
authors.lastname: Carare
authors.forename: Ignat
authors.initials: I
authors.lastname: Petrov
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Forbes
authors.forename: Anita
authors.initials: A
authors.lastname: Saigal
authors.forename: John H
authors.initials: JH
authors.lastname: Spreadbury
authors.forename: Andrea
authors.initials: A
authors.lastname: Yap
authors.forename: Tony
authors.initials: T
authors.lastname: Kendrick
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D002031:Bulgaria; D003430:Cross-Sectional Studies; D003469:Culture; D003863:Depression / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D012383:Romania; D012424:Rural Population; D012944:Social Support; D012959:Socioeconomic Factors; D029181:Spirituality; D011795:Surveys and Questionnaires