Clergy Wholeness Study: How Occupational Distress,Depression,and Social Support Inform the Health of Clergy

Abstract

It has been shown that the rate of clergy occupational distress and depression is increasing. This study examines occupational distress, social support, mental health, and spiritual wholeness in Florida clergy. Clergy in our study sample exhibited higher rates of occupational distress than the national average. Significant connections were made between validated instruments used to assess mental health, clergy occupational distress, and social support. More research is needed to understand the potential causal effects.

Keywords

Clergy occupational distress mental health social support well-being

Background

Mental health concerns are on the rise nationwide. The National Alliance on Mental Illness says that 1 in 5 US adults experience mental illness each year, where 50% of all lifetime mental illness begins by age 14, and 75% by age 24 (National Alliance on Mental Illness, 2019). Individuals with depression have a 40% higher risk of developing cardiovascular and metabolic diseases than the general population (National Alliance on Mental Illness, 2019). Depression and anxiety disorders are estimated to cost the world economy US$1 trillion in lost yearly productivity (National Alliance on Mental Illness, 2019). The World Health Organization claims that mental disorders, such as depression, are among the 20 leading causes of disability (Mathers et al., 2008, p. 33). An American Journal of Public Health Editorial by R. Shim and G. Rust states, “mental health comorbidities substantially increase adverse health outcomes and cost for individuals and the broader population. Individuals with serious mental illness die 25 years earlier than the general population” (Shim & Rust, 2013, p. 774). Socioeconomic status, social networks, and social support are considered risk factors affecting mortality in those with serious mental illness (Colton & Manderscheid, 2006, p. 8).

There is a growing concern for caregivers’ mental health and burnout, and those considered to be in the helping professions (Adams et al., 2017). Those in helping disciplines include but are not limited to healthcare workers, social workers, counselors, educators, clergy, etc. (Adams et al., 2017). In their positions, they are required to extend the same care and impact to many others. This constant care and giving of themselves can deplete reserves and result in compassion fatigue (Figley, 1995). For many, compassion fatigue is considered a cost for caring. Francois Mathieu deems it an occupational hazard, “characterized by deep physical and emotional exhaustion and a pronounced change in the helper’s ability to feel empathy for their patients, their loved ones and their co-workers” (Mathieu, 2007, p. 1). Although we greatly benefit from services provided by caregivers, they can suffer with irritability, reduced capacity to feel empathy, and problems with intimacy and personal relationships (Mathieu, 2007, p. 1).

A small but robust body of research covers clergy well-being in the United States and the United Kingdom. Most of this research comes from Duke University, Divinity School, Clergy Health Initiative, the Flourishing in Ministry Project at the University of Notre Dame, and the Lilly Endowment’s Thriving in Ministry initiative.

A team from Duke University, Durham, North Carolina, led by Proeschold-Bell completed a comprehensive study of clergy well-being, measuring levels of depression, anxiety, job stress, guilt about work, doubting one’s call, ministry satisfaction, and financial stress among United Methodist clergy in North Carolina (Proeschold-Bell et al., 2013). These researchers found the self-reported clergy depression prevalence to be 11.1%, significantly higher than a national sample rate of 5.5% at the time of the study (Proeschold-Bell et al., 2013, p. 439). Although unable to compare to a similar national sample, these researchers found a difference in anxiety levels between male and female clergy, with 12.6% for male clergy and 16.7% for female clergy (Proeschold-Bell et al., 2013, p. 447).

The Duke University research presents identifiable factors that contribute to increased rates of clergy depression and anxiety. They include social isolation that often accompanies the clergy role in which pastors have few confidants in their lives, experience loneliness, and professional stressors: job demands; life unpredictability; and financial stress (Proeschold-Bell et al., 2013, p. 446). Proeschold-Bell and Byassee suggest, in their book Faithful and fractured: Responding to the clergy health crisis, that the findings indicate health problems for United Methodist clergy in their study are broadly relevant to all clergy (Proeschold-Bell & Byassee, 2018, p. xix).

Aim

The background presented above and the call from scholars for additional research to understand the tools available for understanding clergy health (Frenk et al., 2013) prompted this study. The Clergy Wholeness Study presented here aimed to measure the clergy occupational distress, social support, mental health, and spiritual wholeness of clergy in Florida.

Study Design

A quantitative cross-sectional design was implemented. Data were collected using an online anonymous Qualtrics survey link where consent provided access. The study used a snowball convenience sample. Recruitment materials (newsletter announcements, e-mails, press-release, etc.) directed interest to a website with study information and an anonymous survey link for access. All active clergy in Florida, regardless of creed or denomination (i.e., non-retired and 18 years or older), were recruited to participate. The study received Institutional Review Board approval from AdventHealth University, Orlando, Florida, in November 2019.

Measures (Tools)

The survey instrument was a 36-item questionnaire format based on the four assessments outlined below to assess clergy occupational distress, social support, mental health and depression, and spiritual wholeness. As far as possible, validated instruments were used or adapted. The sociodemographic characteristics of religious tradition, denomination (if applicable), ministry context, Florida County, gender, race, relationship status, years in ministry, and age were assessed.

Clergy Occupational Distress Index (CODI)

A team of researchers at Duke University, led by Frenk and colleagues, developed and tested the CODI’s reliability and validity. The CODI measures clergy job stress, perceptions of their work (excessive demands from the congregation, frequency of criticism of themselves or their actions, and feelings of loneliness or isolation in their work), and workplace environment (Frenk et al., 2013, p. 398).

Social Support

The study led by Staley and colleagues used a modified form of the 27-item Social Support Questionnaire (SSQ) called the Social Support Questionnaire Short Form (SSQ6) to measure degrees and sources of social support (Staley et al., 2013, p. 843). The original researchers Sarason and colleagues tested the reliability of the 3-question and 6-question versions of the full SSQ, finding the 6-question (SSQ6) measure having higher internal reliability than the 3-question version (SSQ3), and found that 3-question and 6-question versions correlated positively with the longer 27-item SSQ (Sarason et al., 1987, p. 506). This study utilized the same 6-question SSQ6 to assess social support.

Mental Health and Depression

The Patient Health Questionnaire (PHQ-9) is a self-administered 3-page questionnaire. The PHQ-9 assessment is known primarily for the evaluation of mental health and depression. Validation studies confirming diagnostic validity by Spitzer et al. & Kroenke et al. identify a score of 10 or larger (0–27 scale) as being indicative of depression (Kroenke et al., 2001, p. 606; Spitzer et al., 1999, p. 1737–1744).

Spiritual Wholeness

The spiritual wholeness questions are for use in AdventHealth facilities to assess spiritual needs while accessing care through AdventHealth, whether inpatient or outpatient. They consist of four items: Do you have religious beliefs that influence your medical decisions? Do you have someone who loves and cares for you? Do you have a source of joy in your life? Do you have a sense of peace today? These questions have not been validated and are used primarily for the screening and intake of patients.

Data Analysis

Sociodemographic data, general biographical, and contextual information were analyzed descriptively based on the corresponding mean values. Linear regression was utilized to analyze the responses on some validated tools in conjunction with descriptive variables to assess potential predictive values. Further analysis to determine the significance of predictive values required a step-wise method. A one-sample t-test provided a comparative analysis for the study sample data and published national averages of the CODI. Data were gathered using an anonymous link, ensuring confidentiality, and any further potential identifying information was removed in the data cleaning process. All statistical data analysis was performed using SPSS.

Results

Sample Characteristics

A total of 140 individuals responded to the Qualtrics survey. 103 surveys were completed fully, resulting in a 74% completion rate. Some outliers in the data were identified and removed, resulting in 93 completed surveys for analysis. The sample consisted mainly of self-identified Christians (N = 91; prefer not to answer N = 2), and a variety of denominations were represented. The data resembled common gender disparity found in ministerial contexts with males (N = 60) almost doubling females’ responses (N = 33). Two main ministry context groups (91% of the sample) were found in congregational ministers (N = 43) and hospital chaplains (N = 42). A large portion of survey respondents (94.6% of the sample) identified as White (N = 56), Hispanic or Latino (N = 24), and Black or African American (N = 8), with the remaining identifying as Asian (N = 3) or multiracial (N = 2). The spectrum of years in ministry found in our data spanned a minimum of 1 to a maximum of 55 with a total group mean of 22.49 (standard deviation (SD): 12.90). The minimum age was 24, with a maximum age of 76 and a total group mean of 52.52 (SD: 12.53).

PHQ-9

The PHQ-9 score can range from 0–27: 1–4, minimal depression; 5–9, mild depression; 10–14, moderate depression; 15–19, moderately severe depression; and 20–27, severe depression (Kroenke et al., 2001, p. 606). 50.5% of the sample indicated minimal/no depression (N =47); 36.6% of the sample stated mild depression (N =34); 9.7% of the sample were classified as moderate depression (N = 9); and 3.2% of the sample reported moderately severe depression (N = 3).

Predictors

Linear regression was utilized to investigate the predictability of PHQ-9 total scores by age, total years in ministry, SSQ6 total, and CODI total. According to the correlation table shown in Table 1, the following coefficients were found to be statistically significant: age (−0.371; p = 0.051); total years in ministry (−0.273; p = 0.876); SSQ6 total (−0.304; p = 0.118); and CODI total (0.500; p = 0.00).

Table 1.

Correlations.

The regression model indicates that the independent variables (age, total years in ministry, SSQ6 total, and CODI total) accounted for 29% of the dependent variable variance, suggesting a medium effect size (see Table 2).

Table 2.

Regression Model.

The regression analysis resulted in an obtained F value of 10.374 (4.88) with a significance level of 0.000, demonstrating statistical significance. Therefore, it can be concluded that age, years in ministry, SSQ6 total, and CODI total significantly predicted the PHQ-9 total (see Table 3).

Table 3.

Anova.

To better understand the impact of the specific variables, an analysis of coefficients was produced (see Table 4). A stepwise method was applied to understand predictor significance further. Two independent variables (age and CODI total) were identified as significant predictors, accounting for 28.4% of the variance in the PHQ-9 total (see Table 5).

Table 4.

Coefficients.

Table 5.

Stepwise Analysis.

The t-tests were conducted to analyze the PHQ-9 total mean between genders (male and female) and ministry contexts (hospital chaplaincy and other). The Levene’s test statistic (p = 0.573) indicated homogeneity of variances between male and female groups. The obtained t value −0.774 (df = 90, p = 0.441) failed to achieve statistical significance. The Levene’s test statistic (p = 0.096) indicated homogeneity of variances between ministry context groups (hospital chaplaincy and other). The obtained t value was 0.948 (df = 89, p = 0.346), which failed to achieve statistical significance (see Table 6 and Table 7).

Table 6.

Male and Female Comparison.

Table 7.

Ministry Context Comparison.

CODI Analysis

In CODI, background and findings from two samples of clergy, by Frenk and colleagues, and national scores collected via the CODI from the Pulpit and Pew National Survey of Pastoral Leaders are published. One-sample t-test analysis was used to compare these national mean scores to the mean scores obtained in this sample. The five CODI items, along with the CODI total, were assessed.

The CODI criterion, “During the past year… how often have the people in your congregation made too many demands of you? (Demand)” had a mean value of 2.29. t-test analysis with the study sample indicates a significant difference between the sample and population means (t = 2.73, p = 0.008). Thus, it can be concluded that the sample mean is significantly higher than the population mean (see Table 8).

Table 8.

CODI (Demand) Comparison.

The CODI criterion, “During the past year… how often have the people in your congregation been critical of you and the things you have done? (Criticism)” had a mean value of 1.93. t-test analysis with the study sample indicates that there is a significant difference between the sample and population means (t = 2.481, p = 0.015). Thus, it can be concluded that the sample mean is significantly higher than the population mean (see Table 9).

Table 9.

CODI (Criticism) Comparison.

The CODI criterion, “Looking back over the past year…how often have you experienced stress as a result of dealing with congregational members who are critical of you? (Stress from Criticism)” had a test value of 2.11. t-test analysis with the study sample indicates that there is no significant difference between the sample and population means (t = 1.663, p = 0.100) (see Table 10).

Table 10.

CODI (Stress from Criticism) Comparison.

The CODI criterion, “Over the past year…how often have you felt lonely or isolated in your work? (Lonely)” had a mean value of 2.10. t-test analysis with the study sample indicates that there is a significant difference between the sample and population means (t = 3.549, p = 0.001). Thus, it can be concluded that the sample mean is significantly higher than the population mean (see Table 11).

Table 11.

CODI (Lonely) Comparison.

The CODI criterion, “Over the past year…how often have you experienced stress because of the challenges you have in this congregation? (Stress from Challenges)” had a mean value of 2.54. t-test analysis with the study sample indicates that there is a significant difference between the sample and population means (t = 2.422, p = 0.017). Thus, it can be concluded that the sample mean is significantly higher than the population mean (see Table 12.

Table 12.

CODI (Stress from Challenges) Comparison.

From the study sample, CODI total (N = 93) had a mean value of 12.1505 with a standard deviation of 3.55683 and a standard mean error of 0.36833. One-sample t-test analysis was used to compare these sample statistics to the published national mean value of 10.98 (Frenk et al., 2013, p. 403). There is a significant difference between the sample and the population mean values (t = 3.174, p = 0.002). Thus, it can be concluded that the sample mean is significantly higher than the population mean (see Table 13).

Table 13.

CODI-Totals Comparison.

Discussion

The data presented above relate to previous articles’ conclusions and recommendations, further lending credibility to the findings. The study sought to understand the relationship between the utilized assessment tools, the sample rate of depression compared with national averages, and the sample occupational distress results with the published averages. We hypothesized that the CODI and PHQ-9 scores would correlate and show an inverse correlation of these tools with SSQ6 scores. As hypothesized, the CODI and PHQ-9 scores show a correlation. This suggests that clergy suffering from occupational stress are likely to exhibit signs of depression. Another possible interpretation is that clergy who struggle with depression are likely to exhibit signs of occupational stress. More research is needed to understand the nature of this relationship and the possible causal indicators. The SSQ6 does show an inverse correlation with PHQ-9 scores as initially thought. This adds to the abundance of research (Grosch & Olson, 2000), suggesting that social support is essential for mental health. The spiritual wholeness screening questions did not provide useful data for analysis. The need to understand how spiritual health or wellbeing relates to mental health and clergy occupational distress remains. One possible variable worth considering for future research may be found in the literature on spiritual distress. The study sample exhibited a depression rate of 12.9%, which is higher than the self-reported rate in United Methodist clergy of 11.1% (Proeshold-Bell et al., 2013) and the published 2017 national average of 7.1% (National Institute of Mental Health, 2019). The higher rate for our sample could be in part due to low response rates and self-reporting. Even still, these findings suggest that depression among clergy is worth further investigation and intervention. As hypothesized, our study sample exhibited higher occupational distress rates compared to the published national mean averages. Again, these higher rates could be due to the low response rates and self-reporting nature of our study, but it might also reflect the environment in which clergy now face increased demands and vigilance. This study, as do others, finds that age is inversely correlated with rates of depression (Mirowsky & Ross, 1992; Proeshold-Bell et al., 2013; Stordal et al., 2001). This resembles the general effect of age and depression, as shown in other research (Mirowsky and Ross, 1992). Still, more research is needed to understand if there are specific contributing factors for results found in clergy samples. Interestingly, our study shows an inversely correlated relationship between years in ministry and PHQ-9 scores. Thus, individuals with fewer years of ministerial experience exhibit higher reported depression scores. This directly contradicts previous research results where it was found that more years in ministry equated to more depression and anxiety (Proeshold-Bell et al., 2013). This discrepancy may be due to the difference in population, a change in the occupational landscape, different study methodologies, or a combination of factors. More research needs to be done to explore the relationship between years in ministry and depression. This study furthers the understanding of the CODI and builds on the work developed by Frenk and colleagues in their testing of the validity of the CODI (Frenk et al., 2013). Notably, this study shows a relationship between validated instruments (i.e., CODI and PHQ-9) and the corresponding scores that have been warranted by previous research (Frenk et al., 2013), and these should be explored in future studies. The CODI factors of demand, criticism, loneliness, and stress from challenges were found to be significantly higher than the population mean in our sample, which is consistent and corroborates studies that indicate work demands and occupational stress as possible risk factors for burnout (Grosch & Olson, 2000; Proeshold-Bell et al., 2013). This study suggests policy interventions to promote primary prevention (Proeshold-Bell et al., 2013) using a possible combination of assessment tools (i.e., CODI and PHQ-9). This approach could prove useful for the surveillance and prevention of depression and occupational distress in clergy. It is essential to note that this study was developed and executed before the full effects of COVID-19 were being realized in the United States from January 2020 onwards. Nevertheless, it is reasonable to conclude that with the introduction of a pandemic on top of the stressors and variables mentioned in this paper, the results are likely to exacerbate the findings documented here, furthering the need for attention to mental health wellbeing of clergy.

Limitations

This study aimed to assess clergy occupational distress, social support, mental health and depression, and spiritual wholeness of clergy in the state of Florida. Despite the best efforts to maximize reach, the sample collected is still small and should not be considered representative of Florida clergy. The analysis of social support and spiritual wholeness did not yield statistically significant results. Nevertheless, further research would do well to utilize a similar approach to better understand the relationship between different assessments. The sample respondents were primarily Christian, which limits the religious diversity desired. It is also important to note that convenience samples do not always accurately reflect the population (Bryman, 2015). There remains the potential of confounding factors that can affect rates of depression or occupational distress. As a cross-sectional design, this study is limited to understanding the point in time the data were collected and thus ruling out causal inferences. It is essential to note that some variables assessed (i.e., social support, clergy occupational distress, etc.) can result from existing depression and should not be considered causal based on these results. This study also had elements of volunteer participation. There is a concern for the introduction of volunteer bias, as it is generally understood that those who volunteer to participate in surveys do not sufficiently represent the population (Bryman, 2015). Unfortunately, there is limited research provided on clergy well-being, and often the available research is dated. This creates a significant limitation in understanding and developing a contextual and cultural awareness of clergy issues.

Conclusions

Ministers in this study show higher levels of occupational distress and depression when compared to national averages. These findings should raise a general concern about the mental health of and support for clergy. This study also builds on the evidence of apparent adverse health effects for practitioners in the caring professions, enhancing the study’s broad applicability and encouraging other caring vocations to explore utilizing assessment tools in their respective fields. This study shows that comprehensive assessments can provide insight into practitioners’ health using validated tools such as the CODI and the PHQ-9. Further research is recommended to corroborate the use and efficacy of these validated tools. The methodology presented in this article provides a blueprint for study replication in other contexts and geographic locations. There is enough published research on clergy health concerns to warrant faith groups to incorporate assessments to help monitor and prevent occupational distress and depression. Even still, more research is needed to understand better possible interventions that can help mitigate or recover adverse effects caused by declining mental health status in clergy.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Martin Shaw

Martin Shaw serves as a Healthcare Chaplain and Pastoral Education Fellow for AdventHealth. He is a member of the Association of Professional Chaplains and desires to advance the field of Chaplaincy through research. He holds a Master of Divinity from Andrews University and at the time of this publication is completing his Master of Public Health from the University of Florida.

Roy Lukman, earned a PhD in Educational Psychology from Andrews University with a concentration in Research and Measurements. He joined Florida Hospital (now AdventHealth) in 1983 where he served as the Director of Research, Director of Institutional Effectiveness, and the Associate Director for Behavioral Medicine among other positions. He is a well published author and has been active in research throughout his career. He now consults on research design and statistical analysis for both faculty and students at AdventHealth University.

Linda Wright Simmons is an ordained minister in the Presbyterian Church (USA), a Board Certified Chaplain with the Association of Professional Chaplains, and Registered Mental Health Counseling Intern working toward licensure. She has served as a pastor, theological educator, healthcare chaplain, and currently as a Counseling & Wellness Therapist with medical students and a Community Counselor working with homeless and at-risk individuals in Orlando, Florida. She holds a Master of Divinity from the San Francisco Theological Seminary, a Master of Arts in Clinical Mental Health Counseling from the University of Central Florida, and a Doctor of Ministry from McCormick Theological Seminary.

Ramona Reynolds serves as Executive Director of Ministry Education and Research for the AdventHealth Central Division and the Institute of Ministry Education and Research at AdventHealth University. She is a Board Certified Chaplain with the Association of Professional Chaplains, an ACPE Certified Educator, and an ordained minister in the Baptist faith tradition. She holds a Master of Divinity degree from the Southern Baptist Theological Seminary in Louisville, KY, and a Master of Healthcare Administration from AdventHealth University.

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