African American Religious Engagement and Clinical Anxiety Disorders: A Nationally Representative Examination

Background and Purpose: African Americans have lower prevalence rates of anxiety disorders—the most common mental health condition in the United States—than European Americans; but when anxiety disorders do occur, they tend to be comparatively more chronic, functionally impairing, and unresponsive to treatment. Various theories—e.g., prevention model, stressor response model—posit that religious involvement exhibits a salutary effect regarding anxiety. These perspectives may be especially salient for African Americans who report comparatively high levels of religious engagement.

Prior studies examining the relationship between religious engagement and anxiety among African Americans have found mixed results, perhaps due to the use of different samples of varying size and quality. The object of this study was to examine the relationship between religious engagement and clinical anxiety disorders using a nationally representative sample of African Americans.

Methods: To conduct this cross-sectional study, we used data from the National Survey of American Life (NSAL). The NSAL employed a national multi-stage probability design to obtain a nationally representative sample of African Americans (N=3,570). Interviews were typically administered face-to-face in respondents’ homes, and the response rate was 71%.

In addition to control variables, the study included eight measures of religious involvement (e.g., service attendance, prayer). For the dependent measures, a fully structured diagnostic interview was used to assess the 12-month and lifetime prevalence of five anxiety disorders: Panic Disorder, Agoraphobia without panic, Social Phobia, PTSD, and Generalized Anxiety Disorder. Logistic regression was used to examine the relationship between the measures of religious engagement and each anxiety disorder while controlling for possible confounders. All statistical analyses accounted for the complex multi-stage clustered design of the NSAL sample, unequal probabilities of selection, nonresponse, and poststratification to calculate weighted, nationally representative population estimates and standard errors.

Results: In keeping with the prevention model, weekly service attendance was associated with a lower likelihood of 12-month and lifetime Panic Disorder, lifetime Agoraphobia, and 12-month and lifetime PTSD. Prayer was associated with a lower probability of 12-month Agoraphobia, 12-month Social Phobia, and lifetime PTSD. Likewise, listening to religious radio programs was inversely related to 12-month Panic Disorder, and looking to God for strength was inversely related to lifetime Panic Disorder. Conversely, reading religious materials was positively associated with lifetime Generalized Anxiety Disorder (in accordance with the stressor response model).

Conclusions and Implications: Religious involvement was related to all five anxiety disorders examined in this study. Longitudinal studies are needed to clarify the role that religious engagement plays in dealing with anxiety disorders. However, the present findings suggest practitioners should conduct a spiritual assessment to understand the role of religion in African Americans’ lives and its intersection with the presenting problem. When clinically warranted, practitioners might consider interventions that integrate clients’ religious beliefs and behaviors into therapeutic strategies when clients are supportive of such approaches. A small but growing body of outcome research indicates that such interventions are at least as effective as standard interventions. Religiously adapted interventions have been shown to be effective with many outcomes, including anxiety among African Americans.