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Relationship between spirituality and depressive symptoms among inpatient individuals who abuse substances.

This study aims to examine the relationship between spirituality and believing in God's presence and depressive symptoms among 160 inpatient individuals who abuse substances. Findings indicated that both spirituality and believing in God's presence were significant predictors of depressive symptoms, whereby spirituality was inversely related to depressive symptoms and believing in God's presence was positively related to depressive symptoms. These findings may have implications for mental health practitioners considering implementation of spiritually based interventions that can develop and strengthen clients' spirituality.

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In the past 2 decades, mental health and health care professionals have become more interested in examining the effects of spirituality on the recovery process of individuals who have substance-related disorders (Chen, 2006; Jarusiewics, 2000; Koski-Jannes & Turner, 1999; Miller, 1998; O'Connell, 1999; Sandoz, 1999). This interest is largely stemming from the widespread use of spiritually based support groups (e.g., Narcotics Anonymous [NA] and other 12-step groups) in the treatment of addictive diseases (Ellis & Schoenfeld, 1990; Warfield & Goldstein, 1996) and from research indicating their relationship with treatment gains (Chen, 2006; Jarusiewics, 2000; Koski-Jannes & Turner, 1999; O'Connell, 1999; Sandoz, 1999). Support groups such as Alcoholic Anonymous (AA) and NA understand addiction to be both a spiritual and a physical disease. These groups use spiritual components to increase meaning in individuals' lives (Chen, 2006; Jarusiewics, 2000).

There is an increase in research that makes a clear distinction between the two related concepts of spirituality and religiosity. Seidlitz et al. (2002) reported that some theorists hold that both religion and spirituality have the common core characteristic of a search for that which is sacred in life, with sacred being defined as a perception strongly influenced by social factors of either some divine being or some sense of ultimate reality or truth (D. B. Larson, Swyers, & McCullough, 1998). Seidlitz and colleagues noted a distinction between religion and spirituality in which religion involves an identifiable group that both approves of and sets the direction and method of the search for the sacred, whereas spirituality may involve only the individual's search for the sacred. Other researchers have conceptualized religion as an organized system of beliefs, rituals, and worship that a person practices within specific institutional structures (Russinova & Cash, 2007; Walsh, 1998), whereas spirituality, although perhaps the most central function of religion (Pargament et al., 1988), seems to be related to meaning and purpose in life (Diarmuid, 1994). Spirituality also involves a personal life principle that animates a transcendent quality of relationship with God, which may occur either within or outside a formal religion (Russinova & Cash, 2007; Walsh, 1998). Spirituality includes a personal sense of connection to oneself, to the broader social and physical environment, and to what is termed within 12step programs as a higher power (Adams & Bezner, 2000). These programs are based on spiritual principles intended to promote a spiritual renewal that includes believing in and submitting to a power higher than self, the use of prayer and meditation to enhance connectedness to that higher power, and taking the message of spiritual awakening to other addicts (Miller, 1998).

The study of spirituality as a component in therapeutic intervention for individuals who abuse substances has recently received empirical attention. Chen (2006) conducted a quasi-experiment and examined personal and emotional changes in two groups of incarcerated recovering (abstinent) addicts (N = 93) who participated in one of two year-long intervention programs. One intervention consisted of social support only (NA meetings) and was provided to one group of inmates (n = 50). The second intervention, provided to a group of inmates (n = 43), consisted of both social support (NA meetings) and a 12-step therapeutic program. Results indicated that individuals who participated in the social support and 12-step program reported higher sense of coherence and meaning in life and a reduction in the intensity of anxiety, depression, and hostility compared with the other group, which received only social support. These results replicated previous studies suggesting that behavioral changes in recovery from substance abuse and sustained abstinence appear to be a product of participation in a 12-step program (Miller, 1998; O'Connell, 1999).

In addition to improving addiction treatment outcome, spirituality also appears to have a key role in sustaining therapeutic gains (Koski-Jannes & Turner, 1999). For example, research has shown that individuals who abuse substances who relapsed were more likely to report lower levels of spirituality than those who remained abstinent (Jarusiewics, 2000). Thus, spirituality seems to be an essential component of a successful addiction recovery treatment (Chen, 2006; Jarusiewics, 2000; Koski-Jannes & Turner, 1999; Miller, 1998; O'Connell, 1999; Sandoz, 1999).

The reasons for the consistent inverse relationship between spirituality and substance abuse are unclear. Some researchers have suggested that spirituality works to buffer individuals who are recovering addicts against negative emotions (Warfield & Goldstein, 1996) and to give them an effective way of dealing with stress (Corrington, 1989). Carroll (1993), however, has suggested that recovering individuals may benefit from spiritual practices through an increased sense of optimism and purpose or meaning in life. It seems important to increase purpose or meaning in life because the lack of meaning has been noted in both substance use disorders (Chapman, 1996; Kurtz & Ketchman, 1992) and major depressive disorders (DuPont, 1998; Harlow, Newcomb, & Bentler, 1986). Furthermore, Daaleman and Kaufman (2006) found that spirituality was independently and inversely related to depressive symptoms among 550 adult outpatients recruited from family practices. Thus, it is possible--particularly considering the elevated comorbidity rates between substance abuse disorders and depressive disorders (Brienza et al., 2000; Grant et al., 2004; Klein, Schwartz, Rose, & Leader, 2000; Regier et al., 1990)--that spirituality may have an impact on depression, which in turn might have an impact on substance abuse.

Several instruments have been developed to measure the construct of spirituality. Paloutzian and Ellison (1982) developed the Spiritual Well-Being Scale, which contains subscales differentiating between existential well-being (life purpose and satisfaction) and religious well-being (well-being specifically in relation to God). Subsequently, two more scales were developed during the 1990s. Hall and Edwards (1996) developed the Spiritual Assessment Inventory (SAI), which was designed to assess spiritual maturity. This instrument assesses the respondent's awareness of God in daily life and his or her relationship with God from an object relations perspective. Piedmont (1997) later developed the Transcendence Scale to assess the respondent's sense of universality, prayer fulfillment, and sense of connectedness.

More recently, Seidlitz et al. (2002) developed the Spiritual Transcendence Index (STI). The STI focuses specifically on the perceived psychological effects of respondents' spirituality and intentionally avoids reference to religion, which the developers believed would connote organized religion to many of the respondents. The scale contains two subscales that the authors identify as Spiritual and Belief in God's Presence (hereinafter referred to as God). Seidlitz et al. noted that the Spiritual subscale focuses on experiences that involve respondents' perceptions of their own spirituality, whereas the God subscale focuses on experiences deriving from the respondent's perceived relationship with God. The authors developed the scale in an effort to provide a measure of spirituality that would be effective with more "atheistic forms of spirituality" (p. 441) such as Buddhism and New Age spirituality.

We were intrigued by the possibility that the STI might be a particularly effective instrument to measure spirituality in a population of those who are abusing substances because of the lack of empirical support for the group's sense of transcendent or spiritual connectedness. Because, as mentioned previously, spirituality is also associated with lower levels of depression, we decided to use the STI to measure spirituality in a group of inpatient individuals who abuse substances and examine its relationship to depressive symptoms among these respondents. Whereas previous studies using community samples have used only the STI total score (Kim & Seidlitz, 2002; Seidlitz et al., 2002), the current study examines the two STI subscales separately (see more in the Measures section) in this population to explore possible differences in the responses to the constructs involved in the subscales. The research question is as follows: What is the relationship between depressive symptoms and both spirituality and belief in God's presence? Although no studies examining differences in the STI subscales were found in the literature, we believed that based on the spirituality literature discussed, it was reasonable to hypothesize an inverse relationship between these constructs.

Method

Participants

This is a cross-sectional study of clients receiving treatment at a residential substance abuse agency of approximately 30-days stay located in southeastern Florida. The clients served in this agency come from different geographical areas across the United States. The university's institutional review board reviewed the consent forms, the study protocol including the protection of participants and confidentiality, and the study questionnaires. After obtaining institutional review board approval, the study questionnaires were administered at the treatment agency. The two main instruments used for this study were part of a questionnaire packet containing eight measures; the depression instrument was the second instrument and the spirituality scale was the seventh. The order of these instruments was not randomized but was determined based on the following: (a) conventional wisdom that suggests that instruments should begin with simple, descriptive, and nonsensitive questions to a more specific, sensitive, and elaborate topic (Bowling, 1997) and (b) assessing ways to avoid that respondents may produce different patterns of responses as the previous instrument desensitizes or familiarizes them with a particular topic. Clients who were in attendance on the date that the questionnaires were administered were asked to voluntarily participate in the study. All clients in attendance on that date participated. Clients did not receive any monetary incentive for their participation; however, the consent form clearly specified that their participation would make important contributions to the field of addiction. One hundred and sixty clients volunteered to participate in the study and received the appropriate informed consent forms and a packet with the study questionnaires. Inclusion criteria were clients age 18 years or older attending the treatment agency. The data set did not include information about the length of stay for participants.

Measures

Spirituality. The STI (Seidlitz et al., 2002) was used to measure spirituality. The STI is an eight-item self-report instrument that specifically assesses the construct of spiritual transcendence (Seidlitz et al., 2002). The STI consists of two subscales: the God subscale ("I maintain an inner awareness of God's presence in my life," "I try to strengthen my relationship with God," "God helps me to rise above my immediate circumstances," and "I experience a deep communion with God") and the Spiritual subscale ("My spirituality gives me a feeling of fulfillment," "Even when I experience problems, I can find spiritual peace within," "Maintaining my spirituality is a priority for me," and "My spirituality helps me to understand my life's purpose"). The items were answered with a 6-point Likert-type scale that ranges from 1 = strongly disagree to 6 = strongly agree. The STI score is obtained based on the average rating of all the items, whereby higher scores indicate higher levels of spirituality. The developers used three distinct samples: a community, a seminary, and a convention sample to assess the validity of the scale. Results indicated a lower mean score in the community sample (M = 4.16) relative to both the convention sample (M = 5.09) and the seminary sample (M = 5.12). The STI's test-retest reliability based on a 4-week interval has been reported as .86 (Kim & Seidlitz, 2002). This scale has also demonstrated high internal consistency and validity (Cronbach's [alpha] = .90 to .97). In a community sample of 220 respondents, the STI demonstrated convergent evidence through significant correlations with the Duke University Religion Index (Koening, Parkerson, & Meador, 1997) total score (.87), as well as the Self-Regulation Questionnaire-Religiousness (short version; Ryan, Rigby, & King, 1993) scale score (.86; Seidlitz et al., 2002). In this sample, the internal consistency reliability was assessed by calculating coefficient alpha, which was .96 for the total scale score. The two STI subscales were highly correlated with each other (r = .90, p < .001). Although these subscales are highly correlated, Seidlitz et al. (2002) indicated that the Spiritual subscale focuses on "experiences specifically deriving from the respondent's own conceptualization of spirituality" (p. 441), whereas the God subscale focuses on experiences deriving from the respondent's perceived relationship with God. The subscales were developed in an effort to provide a measure of spirituality that would be effective with more "atheistic forms of spirituality" (Seidlitz et al., 2002, p. 441).

Depressive symptomatology. The Center for Epidemiologic Studies-Depression Scale (CES-D; Radloff, 1977) was used to assess the current level of depressive symptomatology. The CES-D is a 20-item self-report scale designed for use in the general population. This scale has been used in recent research with individuals who abuse substances (M. J. Larson et al., 2007; Sofuoglu, Poling, Gonzalez, Gonsai, & Kosten, 2006; Strathdee et al., 2006). Participants are asked how often they experienced each symptom during the previous week rating their responses on a 4-point Likert scale. Response categories are as follows: 0 = rarely or none of the time (less than 1 day), 1 = some or little of the time (1-2 days), 2 = occasionally or a moderate amount of time (3-4 days), and 3 = most or all of the time (5-7 days). The total score is the sum of these 20 items, which can range from 0 to 60. The cutoff score of 16 or more designates the respondent as depressed (Myers & Weissman, 1980; Schulberg et al., 1985). The CES-D has demonstrated high reliability in a variety of clinical and community samples (Orme, Reis, & Herz, 1986; Radloff, 1977, 1987). Estimates of internal consistency and split-half reliability have been adequate, and fair test-retest reliability has been reported for the time interval ranging from 2 weeks to 1 year (Radloff, 1987). In this sample, internal consistency reliability was assessed by calculating coefficient alpha, which was .81 for the total scale.

Other variables. Age and gender were assessed using self-report items. Ethnicity was measured by asking participants to select which of the following ethnic categories they identify with being: African American, Caribbean/West Indian, European American, or other. A separate binary (yes or no) item asked if they were Latinos, and a contingency item asked them to specify their nationality. Marital status was assessed by asking participants to identify whether they were single, legally married, cohabitating with partner (but not married), or divorced. Employment status was measured by asking participants to select from the following: work 40 hours per week or more, work fewer than 40 hours per week, homemaker, retired, or unemployed. Religious affiliation was measured by using a single item asking participants the following: What is your religious affiliation? Possible response categories were Catholic, Baptist, Episcopalian, Pentecostal, other Protestant (specified), Adventist, Jehovah's Witness, Mormon, Judaism, Islam, Buddhism, Afro Caribbean (specified), and other (specified). Income was measured by asking participants to identify their total household income from specific response categories including the following: less than $4,000, $4,000-9,999, $10,000-$15,999, and so on.

Data Analysis

Hierarchical multiple regression analysis was used to identify the optimal set of predictor variables for the construct of depressive symptoms. The predictor variables were entered in Block 1 and the remaining individual characteristic variables were entered in Block 2, using an alpha of .05, thus ensuring that the overall error rate across all significant tests was reasonable. Zero-order correlations between the predictor variables and the amount of variance in the dependent variable were computed to test the relationship between all other variables and to determine their significance to depression. The number of respondents in some analyses varied because of missing data.

Results

The overall sample had a mean age of 38.57 years (SD = 11.31), ranging from 18 to 67 years old. Approximately 67% were male (n = 108), 48.1% were European American (n = 77), 1.9% were Caribbean/West Indian (n = 3), 8.8% were African American (n = 14), 2.5% were Native African (n = 4), 3.8% were Latino (n = 6), 1.3% were Asian American (n = 2), and 31.3% were other (n = 50). Unfortunately, no data exist specifying the ethnic group of respondents who self-identified as other. In addition, 50.1% of the sample reported they were employed (n = 78), 38.8% were single (n = 62), and 33.1% were legally married (n = 53). Approximately 33% indicated being a high school graduate, and 42% reported having partial college training. Approximately 25% of the sample reported having a university degree or graduate school. In terms of religious affiliations, 50.6% of participants were Catholics.

Bivariate Analyses

Out of the 160 participants, 134 completed the CES-D. Approximately 62.7% (n = 84) out of the 134 participants scored 16 or higher on the CESD, indicating high levels of depressive symptoms and high risk for clinical depression. Respondents who reported high levels of depressive symptoms did not differ from those who reported low levels of depressive symptoms on gender, age, ethnicity, marital status, religious affiliations, and income. Catholics did not differ from non-Catholics in terms of level of depressive symptoms, [chi square] (1, N = 134) = 0.07, p = .79. However, the two groups differed on employment status, [chi square](2, N = 131) = 7.72, p = .02. Of all respondents indicating high level of depressive symptoms (n = 84), approximately 43% (n = 35) reported working 40 hours or more per week and 43% (n = 35) reported being unemployed, retired, or a homemaker compared with 67% (n = 33) and 27% (n = 13) of the nondepressed group reporting working 40 hours or more per week or being unemployed, retired, or a homemaker, respectively.

Hierarchical Multiple Regression Model

Two models were generated as described in the Data Analysis section. The models were checked to ensure that all assumptions of the hierarchical multiple regression were met.

Table 1 provides the results of the hierarchical multiple regression analysis. The first model, containing only Spiritual and God subscales, explained approximately 14% of the variance in depressive symptomatology. In this model, Spiritual ([beta] = -.82) and God ([beta] = .62) subscales were both significant predictors of depressive symptoms but surprising in that they were in opposite directions. That is, there was a positive association between God and depressive symptoms, indicating that participants who reported more belief in God's presence in their lives reported higher levels of depressive symptoms. In contrast, there was an inverse relationship between spirituality and levels of depressive symptoms, indicating that participants who reported higher levels of spirituality reported lower levels of depressive symptoms, [R.sup.2] = .14, F(2, 121) = 9.81, p < .001.

The demographic characteristics were entered as control variables In Model 2 to determine possible changes in the relationship between Spiritual and God subscales once these variables were accounted for. Results of the regression indicated that the same variables as in Model 1 remained significant predictors of depressive symptoms (God, [beta] = .55; Spiritual, [beta] = -.80), [R.sup.2] = .23, F(8, 99) = 3.62, p < .05. Although none of the demographic variables was a statistically significant predictor of depressive symptomatology, their inclusion in the model increased the amount of explained variance by 9% to a total of almost 23%.

Discussion

There is a substantial amount of research indicating elevated comorbidity rates between depressive symptoms and substance abuse disorders. The results of the current study are congruent with that literature, with approximately 63% of the participants who completed the CES-D reporting high levels of depressive symptoms. Furthermore, the findings of this study are consistent with existing literature indicating that spirituality is significantly and inversely related to depressive symptoms (Daaleman & Kaufman, 2006; Kendler et al., 2003). In the current study, individuals who abuse substances who reported higher levels of spirituality were more likely to report lower levels of depressive symptoms.

This finding is not surprising because spirituality involves meaning and purpose in life (Diarmuid, 1994) and a personal sense of connection to oneself and others, which may minimize loneliness and despair leading to feelings of hope, optimism, and a sense of well-being. The association between feelings of hope and therapeutic gain has long been noted (Frank, 1968; French, 1952; Menninger, 1959; Perlman, 1957). French (1952) and Menninger (1959) pointed out the role of hope in initiating therapeutic change, willingness to learn, and feeling a sense of well-being. Perlman (1957) described hope as a key ingredient in a client's motivation for change. Stimulating hope is seen as the requisite first step in activating a client's motivation to change (Kaplan & Girard, 1994). Lazarus (1980) maintained that hope is an essential feature in stimulating change within the therapeutic process. Hope has been characterized as one of the nonspecific factors related to the effectiveness of psychotherapy (Perlman, 1957) and as a universal process useful in multicultural counseling (Fisher, Jome, & Atkinson, 1998). In fact, hope has been described as (a) a protective factor against psychological and physical illnesses (Arnold, 2004), (b) a crucial element for human development and adaptation (Snyder et al., 1991), (c) an important coping mechanism to manage life transitions and challenges (Farran, Herth, & Popovich, 1995; Snyder et al., 1991), (d) a critical factor in the use of services (Compton & Gallaway, 1999), and (e) an essential component of mental health (Vande Kemp, 1984).

Whereas the Spiritual subscale was indeed negatively related to depressive symptoms as expected, the God subscale was positively related to depressive symptoms. That is, the stronger the belief in the presence of God reported by respondents, the higher the level of depressive symptoms. These findings were unexpected and counterintuitive concerning the relationships between belief in God's presence and depressive symptoms.

One possible explanation for these unexpected and counterintuitive results could be that respondents who reported greater belief in God's presence in their lives may have a concept of God as being judgmental and punitive. A strong belief in the presence of a judgmental and punitive God might contribute to a sense of vulnerability resulting in depressive symptomatology. Furthermore, a belief in a judgmental and punitive God might encourage feelings of shame and guilt (Braam, Sonnenberg, Beekman, Deeg, & van Tilberg, 2000; Demaria & Kassinove, 1988) about past life events and/or current substance-related behaviors that could contribute to depressive symptoms. Future studies should explore the relationship between perception of God and depressive symptoms in this population.

An alternative explanation for the unexpected results concerning the God subscale could involve respondents' locus of control. Research has shown that external locus of control can affect the efficacy of treatment in clients who are depressed (Hooke & Page, 2002). It might be that individuals who abuse substances who have a stronger belief in God's presence may tend to have more external locus of control, perhaps expecting that their God should save them from their problems. This expectation would be similar to the tendency among individuals with substance use disorders to blame their problems on other people and events, rather than on personal decisions. This perception of lack of personal control could then contribute to their depressive symptoms and maintain their addictive behaviors.

Implications for Clinical Practice

The findings in this study could be useful to mental health practitioners because they indicate that spirituality is a potential protective factor for depressive symptoms among those who abuse substances. However, the counterintuitive results concerning the STI God subscale also suggest that some caution about individual clients' perceptions of spirituality should be considered. Spiritually based programs could provide interventions directed to helping individuals who abuse substances and are depressed find and maintain a spiritual base, thereby possibly enhancing their treatment outcomes. These programs should purposefully encourage a personal meaning-centered approach, focusing on developing and strengthening clients' spirituality and taking into account the multiple complexities of clients' realities and beliefs. The results presented in this study suggest that practitioners who work with individuals who abuse substances and are depressed should consider asking their clients about their spiritual and religious beliefs to determine how these beliefs might affect their emotional functioning. Practitioners should use a nonjudgmental and empathic partnership with their clients to openly discuss aspects related to spirituality because, as suggested here, spirituality may be linked to clients' addictive behaviors and mental-health-related issues. These clinical implications are consistent with the spiritual competencies developed by the Association for Spiritual, Ethical and Religious Values in Counseling (2009); more specifically, Competencies 7 through 9 indicate that counselors need to be appreciative of clients' spiritual and religious beliefs and assess these beliefs because they are crucial to clients' therapeutic goals.

Limitations

A number of methodological issues must be considered when interpreting the findings of this study. The study population's representativeness and generalizability may be limited to inpatient substance abusers attending treatment facilities in large urban areas. In addition, the sample involved a convenience sample that might have excluded substance abusers in detoxification units who are in a much more severe clinical stage of the substance abuse process. Furthermore, the STI has never been used with a population of those who abuse substances; however, the scale reliability in this sample was excellent. Future research must replicate this study and further explore spirituality and depressive symptoms using other measures of spirituality. It is also possible to speculate that the order in which the instruments were administrated could have affected participants' responses; thus, it is crucial that this study should be replicated. Another possible limitation in this study is that respondents were not asked their length of stay at the treatment facility, a factor that might have affected their perception of spirituality. The sample of this study was predominantly European American and failed to represent different ethnic subgroups. Therefore, caution is necessary when generalizing the results to other ethnic groups. Finally, the high proportion of respondents self-reporting Catholic religious affiliation may have affected the results in unknown ways. Future research in this area should include more balanced religious groupings. Finally, because of the effect of Type I error in our statistical analyses, there is a 10% chance that the variables examined in this study are not actually related as suggested by our findings.

Despite these limitations, the current study has several conceptual and methodological strengths. This is the first study that examines spirituality as a predictor of depressive symptoms in a sample of inpatient individuals who abuse substances. Because of the scarcity of research in this area, the methods of this study were appropriate and allowed for the examination of associations between multiple variables. Another strength of this study was that the sample size allowed for multivariate analyses. Finally, the study was a collaboration between a community-based agency and university-based researchers, a relationship that promotes the development of both evidenced-based practice and practice-based research, and works to reduce the harmful effects of the research-practice schism long noted in the literature (Davis, 2006; Fraser, 1994; Richey, Blythe, & Berlin, 1987; Rosenblatt, 1968).

Future research should replicate this study to provide further empirical evidence for the results and inconsistencies found in this study. In addition, future research should continue to explore risk and protective factors for depressive symptoms among individuals who abuse substances. This research is imperative to better understand factors affecting individuals experiencing a dual diagnosis. Moreover, this study should be replicated using an ethnically diverse sample to determine whether these findings are generalizable to other ethnic groups. Furthermore, future research would benefit from having a longitudinal design with prospective measurement of risk and protective factors to assess the impact of these factors on treatment outcomes over time and to establish the causal pathways.

Conclusion and Future Prospects

Empirical evidence indicates that spirituality is an essential component in the treatment of addictive disorders. However, the mechanisms behind this phenomenon are unclear. It is possible that spirituality has an effect on depressive symptoms, affecting the substance-abuse-related behaviors. The purpose of this study was to examine the relationship between spirituality, belief in God's presence, and depressive symptoms among inpatient individuals who abuse substances. This study differentiated spirituality and belief in God's presence to determine if these two constructs had a distinct effect on predicting depressive symptoms. Findings indicated that spirituality was inversely related to depressive symptoms, whereas belief in God's presence was positively related to depressive symptoms. The findings support the important role of spirituality in the field of addiction and suggest that spiritually based interventions may be effective in reducing depressive symptoms in this population. Future investigations should replicate these findings in a larger, more heterogeneous sample of individuals who abuse substances and incorporate other risk and protective factors related to depressive symptoms, including history of trauma and parental bonding factors.

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Naelys Diaz, E. Gail Horton, and Diane Green, School of Social Work, Florida Atlantic University; John McIlveen, Michael Weiner, and Donald Mullaney, Behavioral Health of the Palm Beaches, Inc., North Palm Beach, Florida. We regret to inform readers that Donald Mullaney died in July 2009. Correspondence concerning this article should be addressed to Naelys Diaz, School of Social Work, Florida Atlantic University, 777 Glades Road, SO284, Boca Raton, FL 33431 (e-mail: ndiaz10@fau.edu).
TABLE 1
Hierarchical Multiple Regression Model Regressing Depressive
Symptoms on Believing in God's Presence (God Subscale) and
Spiritual Subscale and Demographic Characteristics

                                             Model 1

Variable                                B      SE     [beta]

Spiritual Transcendence Index (STI)
  God subscale                         1.17   3.65    .62 *
  Spiritual subscale                  -1.58   3.77   -.82 **
Gender
Ethnicity
Marital status
Religious affirmation
Employment
Income

[R.sup.2]                              0.14
Adjusted [R.sup.2]                     0.13

                                              Model 2

Variable                                B      SE    [beta]

Spiritual Transcendence Index (STI)
  God subscale                         1.08   0.41    .55 *
  Spiritual subscale                  -1.60   0.42   -.80 **
Gender                                 0.09   2.35    .00
Ethnicity                             -0.08   0.72   -.01
Marital status                         0.01   0.78    .00
Religious affirmation                  0.00   0.23    .00
Employment                             0.81   0.64    .12
Income                                -0.71   0.38   -.19

[R.sup.2]                              0.23
Adjusted [R.sup.2]                     0.16

Note. Model 1 = STI subscales. Model 2 = STI subscales and
demographic variables. * p<.05.** p<.001.
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Author:Diaz, Naelys; Horton, E. Gail; Green, Diane; McIlveen, John; Weiner, Michael; Mullaney, Donald
Publication:Counseling and Values
Article Type:Report
Geographic Code:1USA
Date:Oct 1, 2011
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