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THE IMPACT OF ADOLESCENT SPIRITUALITY ON DEPRESSIVE SYMPTOMS AND HEALTH RISK BEHAVIORS Sian Cotton, PhD 1,2 , Elizabeth Larkin, MS 1 , Andrea Hoopes 1 , Barbara A. Cromer, MD 1 , Susan L. Rosenthal, PhD 3

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Sian Cotton, PhD1,2, Elizabeth Larkin, MS1, Andrea Hoopes1, Barbara A. Cromer, MD1, Susan L. Rosenthal, PhD3

1Center for Adolescent Health, Case Western Reserve University School of Medicine, Cleveland, Ohio

2Department of Pediatrics, Rainbow Babies & Children’s Hospital, Cleveland, Ohio

3Division of Adolescent & Behavioral Health, Department of Pediatrics, University of Texas, Medical Branch at Galveston



  • Most of these adolescents reported some connection with religious and spiritual concepts
  • Those adolescents with higher levels of spiritual well-being, in particular, existential well-being, had fewer depressive symptoms and fewer risk-taking behaviors
  • These findings support the inclusion of these concepts in our efforts to help promote resilience and healthy adolescent development, and in expanding our investigations beyond religious identification or attendance to broader concepts of spirituality
  • Spirituality may provide adolescents one source of support from which to derive meaning and purpose, thus fostering resilience and ensuring improved odds of navigating life successfully


  • Explanatory pathways (social support, health behaviors, religious teachings/values, meaning/sense-of-coherence) for the relationships between religion and health need to be empirically tested
  • Longitudinal designs to account for developmental changes and that help address the issue of directionality
  • Cross-cultural investigations to examine these relationships in different cultural (e.g., Hispanics) and religious groups (e.g., Eastern religions)
  • A well-designed psychometrically sound measure of adolescent spirituality is warranted


    • Majority of sample Caucasian (91%)
    • Mean age 16.2 years
    • 55% females and 45% males


  • 68% reported that their relationship to a Higher Power/God contributes to their overall well-being.
  • 77% felt good about their future and 86% believed that their lives had a “real purpose”
  • After controlling for demographics and religiosity, existential well-being and religious well-being accounted for an additional 29% of the variability in depressive symptoms and 17% of the variability in risk behaviors.
  • Existential well-being was the only predictor significant in both final models (p<.01).

(216) 368-5907

(216) 368-4884

Table 1: Correlation Matrix

  • To examine spirituality as an important construct in adolescents’ lives, and
  • To examine the contribution of spirituality, above and beyond that of religiosity, to symptoms and health risk behaviors.

Center for Adolescent Health


  • Research has established a relationship between religiosity, as defined by the formal, institutional, and outward expression of the sacred, and adolescent mental health and health risk behaviors
    • Adolescents who believe in God, rate religion as important in their lives, and attend religious services are less depressed, and less likely to engage in health risk behaviors (i.e., risky sexual behavior and substance use)
  • Spirituality is a construct that incorporates religiosity, but also extends further to include additional concepts such as spiritual well-being, peace and comfort derived from faith, and spiritual coping
  • Few studies have examined the relative contribution of religiosity and spirituality on adolescent health outcomes


  • 134 adolescents from a suburban high school completed a questionnaire assessing spirituality, religiosity, depressive symptoms, and health-risk behaviors
  • Spirituality was measured with two subscales: 1) religious well-being (“I believe that God loves/cares about me”) and 2) existential well-being (“Life doesn’t have much meaning”).
  • Religiosity was assessed via belief in God/Higher Power and importance of religion.
  • The Children’s Depression Inventory-Short Form and the Youth Risk Behavior Survey were used to assess depressive symptoms and health-risk behaviors.

Importance of Religion

Table 2: Multivariate Linear Regression Models Correlating Spirituality with Depressive Symptoms and Health Risk Behaviors

*p<.05, **p<.001

Belief in God



*p<.05, **p<.001