We argue that perceived support is best conceptualized more as a measure of how an individual appraises his/her situation rather than a true reflection of how much support he/she receives. To test this theory, we used survey data from the Clergy Health Initiative Panel Survey to examine the relationship between perceived and received social support and their association with depressive symptoms in clergy (N = 1,288). Overall, analyses revealed perceived support had a weak association with received support. Greater perceived support had a significant relationship with lower depressive symptoms. In contrast, greater received support had only a small relationship with lower depressive symptoms, which was fully mediated by perceived support. Our results raise questions about the effectiveness of many clergy social support interventions, which often aim to boost the quality and/or quantity of received social support. We suggest it may be more advantageous to boost perceptions of social support, possibly through cognitive reframing or positive mental health interventions.

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.

Among adults with HIV/AIDS and co-occurring MH and SA disorders, utilization of MH and SA services needs to be improved.

No abstract

Culturally competent health interventions require an understanding of the population's beliefs and the pressures they experience. Research to date on the health-related beliefs and experiences of clergy lacks a comprehensive data-driven model of clergy health. Eleven focus groups with 59 United Methodist Church (UMC) pastors and 29 UMC District Superintendents were conducted in 2008. Participants discussed their conceptualization of health and barriers to, and facilitators of, health promotion. Audiotape transcriptions were coded by two people each and analyzed using grounded theory methodology. A model of health for UMC clergy is proposed that categorizes 42 moderators of health into each of five levels drawn from the Socioecological Framework: Intrapersonal, Interpersonal, Congregational, United Methodist Institutional, and Civic Community. Clergy health is mediated by stress and self-care and coping practices. Implications for future research and clergy health interventions are discussed.

No abstract

Clergy fulfill vital societal functions as meaning makers and community builders. Partly because of their important roles, clergy frequently encounter stressful situations. Further, studies suggest that clergy experience high rates of depression. Despite this, few studies have examined protective factors for clergy that may increase their positive mental health. We invited all United Methodist clergy in North Carolina to participate in a survey. Of church‐serving clergy, 85 percent responded (n = 1,476). Hierarchical multiple regression was used to assess the predictors of three positive and four negative mental health outcomes. The three sets of predictors were: demographics, which explained 2–10 percent of the variances; variables typically related to mental health (social support, social isolation, and financial stress), which explained 14–41 percent of the variances; and clergy‐specific variables, which explained 14–20 percent of the variances, indicating the importance of measuring occupation‐specific variables. Some variables (e.g., congregation demands) significantly related to both positive and negative mental health, whereas others (e.g., positive congregations, congregation support) significantly related primarily to positive mental health. In addition to their intervention implications, these findings support separate consideration for negative versus positive mental health.

OBJECTIVE Traumatic life histories are highly prevalent in people living with HIV/AIDS (PLWHA) and predict sexual risk behaviors, medication adherence, and all-cause mortality. Yet the causal pathways explaining these relationships remain poorly understood. We sought to quantify the association of trauma with negative behavioral and health outcomes and to assess whether those associations were explained by mediation through psychosocial characteristics. METHODS In 611 outpatient PLWHA, we tested whether trauma's influence on later health and behaviors was mediated by coping styles, self efficacy, social support, trust in the medical system, recent stressful life events, mental health, and substance abuse. RESULTS In models adjusting only for sociodemographic and transmission category confounders (estimating total effects), past trauma exposure was associated with 7 behavioral and health outcomes including increased odds or hazard of recent unprotected sex (OR=1.17 per each additional type of trauma, 95% CI=1.07–1.29), medication nonadherence (OR=1.13, 1.02–1.25), hospitalizations (HR=1.12, 1.04–1.22), and HIV disease progression (HR=1.10, 0.98–1.23). When all hypothesized mediators were included, the associations of trauma with health care utilization outcomes were reduced by about 50%, suggesting partial mediation (e.g., OR for hospitalization changed from 1.12 to 1.07) whereas point estimates for behavioral and incident health outcomes remained largely unchanged, suggesting no mediation (e.g., OR for unprotected sex changed from 1.17 to 1.18). Trauma remained associated with most outcomes even after adjusting for all hypothesized psychosocial mediators. CONCLUSIONS These data suggest that past trauma influences adult health and behaviors through pathways other than the psychosocial mediators considered in this model.