title: Using effort-reward imbalance theory to understand high rates of depression and anxiety among clergy.
abstract: The clergy occupation is unique in its combination of role strains and higher calling, putting clergy mental health at risk. We surveyed all United Methodist clergy in North Carolina, and 95% (n = 1,726) responded, with 38% responding via phone interview. We compared clergy phone interview depression rates, assessed using the Patient Health Questionnaire (PHQ-9), to those of in-person interviews in a representative United States sample that also used the PHQ-9. The clergy depression prevalence was 8.7%, significantly higher than the 5.5% rate of the national sample. We used logistic regression to explain depression, and also anxiety, assessed using the Hospital Anxiety and Depression Scale. As hypothesized by effort-reward imbalance theory, several extrinsic demands (job stress, life unpredictability) and intrinsic demands (guilt about not doing enough work, doubting one's call to ministry) significantly predicted depression and anxiety, as did rewards such as ministry satisfaction and lack of financial stress. The high rate of clergy depression signals the need for preventive policies and programs for clergy. The extrinsic and intrinsic demands and rewards suggest specific actions to improve clergy mental health.
authors: Duke Global Health Institute, Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA, rae.jean@duke.edu.
authors: Rae Jean
authors: RJ
authors: Proeschold-Bell
authors: Andrew
authors: A
authors: Miles
authors: Matthew
authors: M
authors: Toth
authors: Christopher
authors: C
authors: Adams
authors: Bruce W
authors: BW
authors: Smith
authors: David
authors: D
authors: Toole
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D002977:Clergy / Q000523:psychology* / Q000706:statistics & numerical data; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D007588:Job Satisfaction; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011582:Psychological Theory; D012201:Reward; D011795:Surveys and Questionnaires; D055815:Young Adult
references: Arch Fam Med. 1997 Nov-Dec;6(6):567-73
references: 9371051
references: J Health Soc Behav. 1992 Sep;33(3):187-205; discussion 206-12
references: 1401846
references: J Occup Environ Med. 2008 Apr;50(4):401-10
references: 18404013
references: Am J Health Promot. 2010 Jan-Feb;24(3):205-13
references: 20073388
references: NCHS Data Brief. 2008 Sep;(7):1-8
references: 19389321
references: Arch Gen Psychiatry. 2005 Jun;62(6):593-602
references: 15939837
references: J Occup Rehabil. 2010 Sep;20(3):275-92
references: 20091105
references: J Clin Psychol. 2000 May;56(5):619-32
references: 10852149
references: Int J Methods Psychiatr Res. 2003;12(1):3-21
references: 12830306
references: J Pastoral Care Counsel. 2002 Winter;56(4):393-403
references: 12564398
references: Am J Psychiatry. 2000 May;157(5):669-82
references: 10784456
references: J Gen Intern Med. 2001 Sep;16(9):606-13
references: 11556941
references: J Public Health (Oxf). 2005 Sep;27(3):281-91
references: 15870099
references: JAMA. 2003 Jun 18;289(23):3095-105
references: 12813115
references: J Pastoral Care. 1995 Summer;49(2):129-47
references: 10154662
references: JAMA. 1999 Nov 10;282(18):1737-44
references: 10568646
references: J Relig Health. 2013 Jun;52(2):397-407
references: 21409478
references: J Prev Interv Community. 2012;40(3):180-93
references: 22694156
references: Health Psychol. 2011 May;30(3):268-75
references: 21553970
references: J Occup Health Psychol. 1996 Jan;1(1):27-41
references: 9547031
references: J Health Soc Behav. 1994 Dec;35(4):291-308
references: 7844327
references: J Psychosom Res. 2002 Feb;52(2):69-77
references: 11832252
references: Health Serv Res. 2003 Apr;38(2):647-73
references: 12785566
references: J Clin Psychol. 1986 May;42(3):540-6
references: 3711357
references: Ann Clin Psychiatry. 2010 Feb;22(1):43-55
references: 20196982
references: Acta Psychiatr Scand. 1983 Jun;67(6):361-70
references: 6880820
references: Health Psychol. 2012 Jul;31(4):503-11
references: 22229931
references: Acta Psychiatr Scand. 2001 Sep;104(3):210-6
references: 11531658
references: Am J Orthopsychiatry. 2011 Jan;81(1):118-27
references: 21219283
references: J Gen Intern Med. 2007 Sep;22(9):1286-91
references: 17597350
references: Ann Intern Med. 2007 Mar 6;146(5):317-25
references: 17339617
references: Am J Addict. 2010 Jul-Aug;19(4):345-51
references: 20653642
references: Br J Clin Psychol. 2001 Nov;40(4):429-34
references: 11760618