1. Introduction
For over two decades, numerous studies have shown that discrimination experiences—interpersonal abuse and injustice—can contribute to poorer mental health, including higher levels of anger, hostility, generalized anxiety, social anxiety, depression, paranoia, post-traumatic stress disorder, somatization, and non-specific psychological distress (
Alvarez and Juang 2010;
Borders and Liang 2011;
Brown et al. 2000;
Brown and Turner 2012;
Feinstein et al. 2012;
Fischer and Holz 2007;
Gayman and Barragan 2013;
Gee et al. 2006,
2007;
Jackson et al. 1995;
Keith et al. 2010;
Kessler et al. 1999;
Lee and Turney 2012;
Miller et al. 2013;
Moradi and Hasan 2004;
Mossakowski 2003;
Noh and Kaspar 2003;
Paradies et al. 2015;
Pascoe and Richman 2009;
Schulz et al. 2006;
Steffen and Bowden 2006;
Taylor and Turner 2002;
Vaghela and Sutin 2016;
Versey and Curtin 2016;
Williams et al. 2003;
Yang and Park 2015). Although this body of work has made significant contributions to our understanding of the psychosocial costs associated with discrimination, the precise pathways to mental health have yet to be established. According to Williams and colleagues (
Williams et al. 2003, p. 205), “one of the most critical needs is for more careful research attention to the specific mechanisms by which perceptions of discrimination might adversely affect health.”
Over the years, researchers have speculated that discrimination might contribute to poorer mental health by exposing individuals to trauma, stress, structural strain, internalized oppression, feelings of ambiguity and loss, negative coping styles, substance use, sleep disturbance, and diminished psychosocial resources like meaning, self-esteem, and the sense of personal control (
Brown et al. 2000;
Clark et al. 1999;
Gee et al. 2006;
Paradies et al. 2015;
Pascoe and Richman 2009;
Williams et al. 2003). However, we could find only eleven direct empirical examinations of the mechanisms linking discrimination and mental health. Briefly, these studies indicate that the association between perceived discrimination and symptoms of psychological distress (anger, hostility, generalized anxiety, social anxiety, depression, and non-specific psychological distress) is at least partially mediated by self-esteem, the sense of personal control, sleep disturbance, structural strain (perceptions of structural and institutional barriers), rumination (brooding over problems), rejection sensitivity (expecting and overreacting to rejection), active coping (efforts to alleviate discrimination), support-seeking (pursuing support for discrimination), and avoidance coping (efforts to ignore discrimination) (
Alvarez and Juang 2010;
Borders and Liang 2011;
Cassidy et al. 2004;
Feinstein et al. 2012;
Fischer and Holz 2007;
Gayman and Barragan 2013;
Keith et al. 2010;
Moradi and Hasan 2004;
Steffen and Bowden 2006;
Versey and Curtin 2016;
Yang and Park 2015).
In this paper, we extend previous research by proposing and testing a new potential mechanism. We consider the possibility that the association between day-to-day discrimination and depressive symptoms is mediated by religious struggles. Stauner and colleagues (
Stauner et al. 2016, p. 1) define religious struggles as “tension and conflict about sacred matters within oneself, with others, and with the supernatural.” There are three general dimensions of religious struggles: (1) Interpersonal; (2) Intrapersonal; and (3) Divine/Demonic (
Exline et al. 2014). Interpersonal struggles refer to religious-based conflicts with family, friends, or less intimate relations within one’s religious group or broader community. Intrapersonal struggles refer to intrapsychic battles with one’s own religious beliefs and behavior, including struggles with internalized morality standards, religious doubts, and the search for meaning in life. While divine struggles refer to negative beliefs about or strained relationships with God or another higher power, demonic struggles refer to ominous beliefs about the devil or other evil spirits.
The idea that religious struggles could link discrimination experiences and mental health is a specific expression of a general conceptual model that has been developed in previous research (
Ai et al. 2010;
Ellison et al. 2010;
Krause and Ellison 2009;
Magyar-Russell and Pargament 2006;
Park 2005;
Wortmann et al. 2011). We call this general model the Strain-Struggles-Distress (S-S-D) model. The S-S-D model has two principle components. The first component (S-S) suggests that stressful experiences can lead to religious struggles.
Magyar-Russell and Pargament (
2006, p. 102) note that “… negative life events, loss, and trauma often shatter previously held assumptions about the benevolence, fairness, and meaningfulness of the world. For many, this shattering of assumptions extends to the spiritual dimension of their lives.” Indeed, several studies have traced the origins of religious struggles to a range of strains, including cancer, congestive heart failure, medical diagnoses, preoperative anxiety, disability, and other stressful or traumatic experiences (
Ai et al. 2010;
Ellison et al. 2010;
Exline et al. 2011;
Fitchett et al. 2004;
Gall et al. 2009;
Krause and Hayward 2012;
Koenig et al. 1998;
Wortmann et al. 2011). When experienced in the context of deeply held religious belief systems, it is often extremely difficult for people to find meaning in stressful events. In many ways, the events contradict the beliefs.
The second component (S-D) suggests that religious struggles can be psychologically distressing.
Exline (
2002, p. 182) explains that “religious belief and involvement can provide many benefits, including social support, a sense of meaning, purpose, and direction for one’s life, an environment that fosters the development of virtue, and perhaps even a close, personal relationship with God. However, problems can arise in any of these areas, creating stumbling blocks that can create personal distress: … interpersonal strains, negative attitudes toward God, inner struggles to believe, and problems associated with virtuous striving.” While most studies of religion and mental health focus on the benefits, a growing body of research has begun to emphasize the so-called “dark side” of religion. In fact, several studies have linked religious struggles to a range of adverse mental health outcomes, including guilt, shame, anger, hostility, generalized anxiety, social anxiety, panic disorder, obsessive compulsive disorder, paranoia, depression, post-traumatic stress disorder, and non-specific psychological distress (
Ai et al. 2010;
Allen et al. 2008;
Ano and Vasconcelles 2005;
Ardelt and Koenig 2006;
Bradshaw et al. 2008,
2010;
Dillon and Wink 2007;
Ellison 1991;
Ellison et al. 2009,
2010,
2013,
2014;
Ellison and Lee 2010;
Exline et al. 1999,
2000,
2011,
2014,
2016;
Exline and Martin 2005;
Fenelon and Danielsen 2016;
Fitchett et al. 2004;
Galek et al. 2007;
Gall et al. 2009;
Hill and Cobb 2011;
Hunsberger et al. 2002;
Koenig et al. 1998;
Krause et al. 1999;
Krause and Wulff 2004;
Krause and Ellison 2009;
Krause 2006;
Mannheimer and Hill 2015;
McConnell et al. 2006;
Nie and Olson 2016;
Pargament et al. 2004;
Smith et al. 2003;
Stauner et al. 2016;
Sternthal et al. 2010;
Trenholm 1998;
Uecker et al. 2016;
Wilt et al. 2016a,
2016b,
2017;
Wortmann et al. 2011). These general patterns are remarkably consistent and can be observed across indicators of religious struggle, including religious doubts, negative religious coping (e.g., feeling abandoned by God), anxious or distant attachments to the divine (e.g., God as unresponsive and cold), negative God images (e.g., God as vengeful and punitive), strained relationships within religious communities, ominous religious beliefs (e.g., believing that human nature is fundamentally perverse and corrupt), and religious cognitive dissonance (e.g., discrepancies between religious beliefs and behaviors).
The first component of our model (S-S) suggests that the intrapsychic challenges of discrimination are likely to trigger two specific forms of religious struggles: religious doubts and negative religious coping. Religious doubts are “feelings of uncertainty toward, or questioning of, religious teachings or beliefs” (
Hunsberger et al. 1993, p. 28). Negative religious coping refers to precarious adaptations to stressful events, including “a tenuous relationship with God, spiritual struggle, and a threatening view of the world” (
Pargament et al. 1998, p. 720). Suffering challenges religious beliefs systems and sows the seeds of doubt (
Exline and Rose 2005). Suffering leads people to question their gods (
Pargament et al. 2005). Eventually suffering leads people to search for meaning in their lives by asking fundamental questions (
Exline et al. 2011;
Grubbs and Exline 2014;
Pargament et al. 2004,
2005;
Park 2005). How can this happen to me when I am a person of faith? If God truly loves me, why do I suffer? Has God abandoned me? Is God punishing me? Systematic and repeated experiences with discrimination—interpersonal abuse and injustice—are inherently stressful and potentially traumatic (
Clark et al. 1999;
Gee et al. 2006;
Kessler et al. 1999;
Williams et al. 2003). Our central argument is that the suffering associated with discrimination can lead to religious doubts and negative religious coping by shattering important beliefs about the benevolence of God, fairness in the world that is bestowed on the faithful, and the sense of meaning that should accompany religious dedication.
Based on the general Strain-Struggles-Distress (S-S-D) model and previous empirical research, we hypothesize that the association between day-to-day discrimination and depressive symptoms will be partially mediated or explained by religious struggles (see
Figure 1). In other words, we expect that day-to-day discrimination will contribute to symptoms of depression by stirring religious struggles—religious doubts and bouts of negative religious coping.
4. Discussion
Although the association between discrimination experiences and mental health is well established, the precise mechanisms are not. To extend previous research, we considered the possibility that the association between day-to-day discrimination and depressive symptoms is at least partially mediated by religious struggles. We found that discrimination experiences were positively associated with religious struggles and depressive symptoms. We also observed that the positive association between discrimination and depression was partially mediated by religious struggles. In the end, our model suggested that religious struggles could serve as a maladaptive coping response to socially patterned experiences with discrimination.
We acknowledge that our work should be considered in the context of several limitations. First and foremost, all analyses are based on cross-sectional data. As a result, it is difficult to determine the direction of the relationships among discrimination experiences, religious struggles, and depressive symptoms. Although previous theory suggests that discrimination and religious struggles can contribute to depression, preexisting symptoms of depression might also contribute to perceptions of discrimination, religious doubts, and negative religious coping. Depression is often characterized by a negative cognitive bias, which can shape the way individuals experience their environments and interpret the world around them. By driving a generally pessimistic orientation toward life, depression could, for example, increase perceptions that one is being discriminated against or beliefs about punishing gods. Although previous longitudinal studies tend to support our proposed conceptual model (e.g.,
Krause 2006;
Nie and Olson 2016;
Pargament et al. 2004;
Schulz et al. 2006), prospective data are needed for verification over time. Although our proposed model is theoretically viable, we cannot exclude the possibility of alternative conceptual models. For example, religious doubts could contribute to symptoms of depression by provoking social sanctions or social conflicts within religious communities (i.e., Struggles-Strain-Distress).
The current study is also limited by our three-item measurement of religious struggles. Although results obtained from an exploratory principal components analysis confirm that these items are sound indicators, reliability is rather low due to the small number of items. Such low reliability suggests that any observed associations are likely to be conservative. This could help to explain why the standardized coefficient for religious struggles (not shown) is smaller in magnitude than the coefficients for our other statistically significant predictors of depressive symptoms. In future research, our analyses should be replicated using more complex and sophisticated measurements of religious struggles (see
Exline et al. 2014;
Pargament et al. 2004;
Stauner et al. 2016). It is also important to examine specific elements of religious struggles (e.g., religious doubts) as potential mechanisms of strain. Research along these lines could provide a more theoretically nuanced understanding of the processes linking strain and distress.
Generalizability is another issue. Most studies of religious struggles are limited to data collected from non-probability samples because large epidemiological surveys rarely include these types of measurements. The use of data collected from a probability sample of Miami-Dade adults clearly advances this body of work, but we cannot overstate the external validity of our conceptual model. Additional research with data collected from national probability samples or other regional probability samples is needed to confirm our results.
Our final limitation is sample size. Because our sample is so small, we were unable to seriously consider any potential subgroup variations in our proposed model. In exploratory analyses (not shown), we estimated a moderated mediation model (
Hayes 2013) to assess whether the indirect effect of discrimination on depression through religious struggles varied according to race and ethnicity. We found that the indirect effect of present in non-Hispanic whites (95% C.I. = 0.028, 0.184), but not non-whites (95% C.I. = −0.006, 0.042). The index of moderated mediation confirmed that the difference in the indirect effects was statistically significant (95% C.I. = 0.013, 0.170). These results suggest that the indirect effect of discrimination on depression through religious struggles was more pronounced for non-Hispanic whites. This pattern was apparently driven by race/ethnic variations in the association between religious struggles and depression, not the association between discrimination and religious struggles. If these patterns can be trusted (given the limitations of our sample), they could be explained by race differences in divine attachments and God images (
Froese and Bader 2010;
Kirkpatrick 1992). If non-Hispanic whites are more likely to have anxious or distant or insecure attachments to the divine and tend to hold more negative or punitive images of God, it is reasonable to expect that religious struggles would be especially distressing for whites. Of course the veracity of these patterns and theories are contingent upon replication and further testing with larger samples.