religiosity and general health among undergraduate students: a response to

Personality and Individual Differences 37 (2004) 485–494www.elsevier.com/locate/paid

Religiosity and general health among undergraduatestudents: a response to O�Connor, Cobb, and O�Connor (2003)

Leslie J. Francis a,*, Mandy Robbins a, Christopher Alan Lewis b,Catherine F. Quigley a, Christopher Wheeler a

a Welsh National Centre for Religious Education, University of Wales, Normal Site, Bangor,

Gwynedd, Wales LL57 2PX, UKb School of Psychology, University of Ulster at Magee College, Northern Ireland

Received 31 March 2003; received in revised form 13 August 2003; accepted 15 September 2003

Available online 19 November 2003

Abstract

To extend the work of O�Connor et al. (2003), a sample of 246 undergraduate students completed theFrancis Scale of Attitude toward Christianity together with the thirty-item version of the General Health

Questionnaire and measures of church attendance, personal prayer, and bible reading. The data demon-

strate that a positive attitude toward Christianity is associated with a higher level of self-reported general

health. Church attendance and personal prayer convey no additional predictive power after attitude toward

Christianity has been taken into account. These findings contradict those of O�Connor et al. (2003) and are

sufficiently important to deserve replication among other samples.

� 2003 Elsevier Ltd. All rights reserved.

Keywords: General Health Questionnaire; Francis Scale of Attitude toward Christianity; Religiosity; Psychological

distress

1. Introduction

The recent study reported by O�Connor et al. (2003) failed to find a significant relationshipbetween religiosity, as assessed by the Francis Scale of Attitude toward Christianity (Francis,1993), and health, as assessed by the General Health Questionnaire (Goldberg, 1978). O�Connor

* Corresponding author. Tel.: +44-1248-382566; fax: +44-1248-383954.

E-mail address: [email protected] (L.J. Francis).

URL: http://www.bangor.ac.uk/rs/pt.

0191-8869/$ - see front matter � 2003 Elsevier Ltd. All rights reserved.

doi:10.1016/j.paid.2003.09.017

mail to: [email protected]

http://www.bangor.ac.uk/rs/pt

486 L.J. Francis et al. / Personality and Individual Differences 37 (2004) 485–494

et al. (2003, pp. 214–215) concluded that �we did not find evidence that religion (and spirituality)had a beneficial effect on mental and physical health status.� Their finding and their conclusion issurprising for three reasons.

First, the finding is surprising because, although there is no unambiguous consensus in theresearch literature, the evidence is more strongly weighted in favour of finding a positive rela-tionship between religiosity and health than in finding either a negative relationship or the absenceof a significant relationship.

Studies, which show a positive link between religiosity and health, include research looking atthe several facets of physical health. For example, Levin and Schiller (1987) uncovered over 250published articles and concluded from their investigation that religiosity, however operationa-lised, appears to exert a salutary effect on physical health. Researchers have reported that reli-giosity may offer a protective factor against cancer (e.g., Berkel & deWaard, 1983; Hamman,Barancik, & Lilienfeld, 1981); hypertension (e.g., Levin & Markides, 1985; Rouse, Armstrong, &Beilin, 1982), and all-cause mortality (e.g., Comstock & Partridge, 1972; Strawbridge, Cohen,Shema, & Kaplan, 1997). For example, Hummer, Rogers, Nam, and Ellison (1999) performed anepidemiological controlled study between religious involvement and adult mortality in the UnitedStates of America, with an 8-year follow-up. This national study consisted of 21,204 participantsinvolved in the 1987 National Health Interview Survey. The religious variable was measured byasking participants to indicate how often they attended religious services. The outcome variablewas cause of death. These researchers reported that frequency of religious attendance was posi-tively related to length of life.

Similarly, research assessing mental health offered comparable findings. In general there ap-pears to be an associative role that religiosity plays in the protection or the reduction of mental oremotional disorders. These disorders include both anxiety (for example, Bergin, Masters, &Richards, 1987; Tapanya, Nicki, & Jarusawad, 1997) and depression (e.g., Koenig & Fritterman,1995; Koenig, George, & Peterson, 1998). For example, Ross (1990) performed a high-quality,community-based epidemiologic study amongst 401 Illinois residents. She reported that aftercontrolling for a variety of socio-demographic variables, individuals with stronger religious beliefshad lower levels of psychological distress.

Likewise, Ellison, Boardman, Williams, and Jackson (2001) conducted a study that consisted ofresidents aged 18 or older. Participants in the sample were also part of the 1995 Detroit AreaStudy (Williams, Yan, Jackson, & Anderson, 1997). These researchers reported that frequency ofchurch attendance and a measure on prayer had salutary effects on distress. Similarly, the findingsremained consistent even after controlling for a number of socio-demographic potential con-founders.

The positive effect that religion operates on mental health has been reported in a number ofreviews (for example, Gartner, Larson, & Allen, 1991; Matthews et al., 1998). These authors arguethere is sufficient evidence in the literature that suggests there to be a preventative effect thatreligion operates on health. In addition, these reviewers comment that this outcome can be viewedregardless of the methodology employed. In a recent review, this general assertion was validated;Koenig, McCullough, and Larson (2001) reported that within the literature there were more then850 articles examining the association between religious involvement and mental health, withmore than two-thirds of the empirical studies showing an advantage to the religiously active.However, the majority of the studies examining the relationship between these two variables

L.J. Francis et al. / Personality and Individual Differences 37 (2004) 485–494 487

consist of single-item or two-item measures mostly reporting low zero-order associations thattypically drop substantially when multiple comparisons are controlled.

By way of comparison, studies which fail to show any relationship between religiosity andhealth are in the minority. In relation to physical health, a few researchers have presented evidencethat provides no association between religiosity and physical health outcomes (for example,Cleary & Houts, 1984; Koenig, Moberg, & Kvale, 1988; Levin & Markides, 1986). For instance,Brown and Gary (1994) surveyed 537 African American men from Virginia. These researchersexamined the relationship between physical illness and religious involvement, as assessed by a 10-item religiosity scale (Kenney, Cromwell, & Vaughan, 1977), frequency of religious attendance,and religious affiliation. Physical health was measured by self-reported presence of hypertension,cigarette smoking, and alcohol use. Researchers found no relationship between religious variablesand hypertension (in uncontrolled analyses).

Similarly, a few studies into aspects of mental health, such as anxiety (for example, Epstein,Tamir, & Natan, 1985), neuroticism (for example, Francis, 1997; Pfeifer & Waelty, 1999), anddepression (for example, Spendlove, West, & Stanish, 1984) have shown no association withreligiosity. In a study using multiple single-item measures associated with religiosity, Idler andKasl (1992) examined the relationship between private religiousness, assessed by self-reports ofreligiousness and strength and support received from religion, public religiousness, assessed byfrequency of attendance at services and by the number of other congregation members known,and depression, assessed by the Center of Epidemiologic Studies Depression Scale (Radloff, 1977).These measures were distributed amongst 2812 elderly people over the age of 65 living in the NewHaven Connecticut area. Results show that within the total sample investigated neither privatereligiousness nor public religiousness was associated with depression.

Even fewer studies show a negative link between religiosity and physical health (for example,Meisenhelder & Chandler, 2000a, 2000b). These researchers found that Church Lay Leaders andmembers of the Presbyterian Church, respectively, who prayed more frequently scored lower onphysical health as assessed by the Medical Outcomes Study Short-Form 36 Health Survey (Ware& Sherbourne, 1992). Generally, the robust findings reported between religiosity and physicalhealth could be linked to the fact that individuals who are more religiously active adhere to morehealth-promoting behaviours (Levin, 1994).

Similarly only a few empirical studies show a negative link between religiosity and mentalhealth, including studies that have examined anxiety (for example, Shooka, Al-Haddad, & Raees,1998; Trenholm, Trent, & Compton, 1998) and depression (for example, Dunn, 1965; Sorenson,Grindstaff, & Turner, 1995). Neeleman and Lewis (1994) performed one of the few studies thathave linked psychotic illness with greater religiosity. These researchers examined a sample of 98patients that came from two university hospitals in London. The study consisted of 26 depressedoutpatients, 26 patients who displayed deliberate self-harm, 21 psychotic patients, and 25 non-psychotic controls. Using a 16-item questionnaire designed to assess religious beliefs and prac-tices, researchers reported that significantly higher scores belonged to those individuals sufferingfrom a psychiatric disorder. Consequently, the psychotic respondents scored the highest, followedby the depressed and parasuicide respondent�s scores.

Second, O�Connor et al. (2003) finding is surprising because the measure of religiosity whichthey employed was designed to access the attitudinal dimension of religion which is generallyregarded as a highly salient dimension of religion for predicting individual differences (Kay &


Francis, 1996). Unlike indicators of religious affiliation, attitude measures are not contaminatedby the problem of nominalism (Fane, 1999). Unlike indicators of religious practice (churchattendance), attitude measures are not contaminated by the problem of personal and contextualinfluences, like ill health which may inhibit attendance or social conformity which may predisposeattendance. Unlike indicators of religious belief, which may force divisions between denomina-tional groups, attitude measures access a deep common core of religiosity. Attitudes representdeep seated underlying predispositions which are more pervasive and more stable than the rela-tively surface dimensions of affiliation, practice, and belief. Moreover, the measure of attitudetoward religion employed by O�Connor et al. (2003), the Francis Scale of Attitude towardChristianity, is a well tested instrument which has been shown to be sensitive to the psychologicalcorrelates of religiosity over a wide area (Kay & Francis, 1996).

Third, O�Connor et al.�s (2003) finding is surprising because, although the Francis Scale ofAttitude toward Christianity has not been used previously alongside the General Health Ques-tionnaire, it has been used significantly alongside another measure of psychological health,namely the Oxford Happiness Inventory (Argyle, Martin, & Crossland, 1989) in a sequence ofstudies reported by Francis and Lester (1997), Francis and Robbins (2000), Francis, Jones, andWilcox (2000), Francis, Robbins, and White (2003), French and Joseph (1999), and Robbins andFrancis (1996). All these studies demonstrated a significant positive correlation between happinessand attitude toward Christianity, after controlling for the possible contaminating influence ofpersonality. On the other hand, no significant relationship was found between attitude towardChristianity and happiness among a sample of 331 students in Germany reported by Francis,Ziebertz, and Lewis (2003).

If it can be assumed that the General Health Questionnaire and the Oxford HappinessInventory access similar aspects of psychological health, O�Connor et al.�s (2003) findings aresurprising. However, there is a second (less well developed) strand of research which has employeda different measure of psychological health alongside the Francis Scale of Attitude towardChristianity, namely the Satisfaction with Life Scale (Diener, Emmons, Larsen, & Griffen, 1985),reported by Lewis (1998), Lewis, Joseph, and Noble (1996), and Lewis, Lanigan, Joseph, and deFockert (1997). All three student samples demonstrated no significant relationship between lifesatisfaction and attitude toward Christianity. If it can be assumed that the General HealthQuestionnaire has more in common with the Satisfaction with Life Scale than with the OxfordHappiness Inventory, then perhaps the findings of O�Connor et al. (2003) may not be so surprisingafter all.

Against this background, the pioneering study reported by O�Connor et al. (2003), whichemployed the Francis Scale of Attitude toward Christianity for the first time alongside theGeneral Health Questionnaire, deserves closer scrutiny. Their data from a sample of 177 full-timeundergraduate students in England and Scotland failed to find any significant relationship be-tween religiosity and health. There are two problems associated with the secure generalisation ofthese conclusions. The first problem concerns the version of the Francis Scale of Attitude towardChristianity employed. By electing to use the seven-item short-form of the scale, O�Connor et al.(2003) may have failed to provide the full range of scale scores best suited for display alongside thethirty-item General Health Questionnaire. The second problem concerns sample sizes and sig-nificance levels. By electing to compute correlations on males and females separately, rather thanusing partial correlations controlling for sex differences, both the sample size and the likelihood of


achieving statistical significance are reduced. By electing to set the probability level at one percent(to protect against type one errors due to multiple comparisons), rather than the conventional fivepercent, the chances of achieving statistical significance are reduced further. Thus, the correlationof )0.23 between attitude toward Christianity and general health recorded among the sample of75 males is counted as failing to provide support for statistical association.

The aim of the present study, therefore, is to extend the work of O�Connor et al. (2003) amonganother sample of undergraduate students, employing the full twenty-four-item scale of attitudetoward Christianity alongside the thirty-item General Health Questionnaire. Additionally, twomeasures of religious behaviour (church attendance and prayer) are included in the study in orderto examine the relationship between the behavioural and the attitudinal dimensions of religiosityin predicting individual differences in self-perceived general health.

2. Method

2.1. Sample

A sample of 246 undergraduate students (84 males and 162 females) from Wales (University ofWales, Bangor) and from Northern Ireland (University of Ulster, Magee College) volunteered toparticipate in the study in the context of student project work. Of the total sample, 30% wereunder the age of 20, 52% were in their twenties, and 18% were aged 30 or over.

2.2. Measures

The Francis Scale of Attitude toward Christianity (Francis, Lewis, Philipchalk, Brown, &Lester, 1995) is a twenty-four item instrument concerned with affective responses to God, Jesus,bible, church, and prayer. Each item is assessed on a five-point Likert scale, ranging from agreestrongly, through not certain, to disagree strongly. Higher scores indicate a more positive attitudetoward Christianity. It is also possible to compute the scores for the short seven-item scale whenthe full twenty-four item instrument is employed.

The General Health Questionnaire (Goldberg & Williams, 1988) is a thirty-item instrumentconcerned with self-evaluation of general health items like �been able to concentrate on whateveryou�re doing�, �been nervous and strung-up all the time�, and �finding it easy to get on with people�.Each item is assessed on a four-point scale, ranging from �better than usual� to �much less thanusual.� Higher scores indicate a poorer level of general health.

Church attendance was assessed on a seven-point scale, ranging from more than once a week toless than once a year.

Personal prayer was assessed on a five-point scale, ranging from daily to never.

2.3. Analysis

The data were analysed by means of the SPSS statistical package (SPSS Inc., 1988) using thefrequency, Pearson correlation, partial correlation, t-test, and regression routines.


3. Results

The two psychometric instruments employed in the study performed with good internal con-sistency reliability: General Health Questionnaire, a ¼ 0:95; Francis Scale of Attitude towardChristianity (fullform), a ¼ 0:97; Francis Scale of Attitude toward Christianity (short form),a ¼ 0:96. Table 1 presents the mean scores for males and females separately on the GeneralHealth Questionnaire, the Francis Scale of Attitude toward Christianity, and the two measures ofreligious behaviour. There were no significant differences between the scores recorded by men andby women on the General Health Questionnaire, the Francis Scale of Attitude toward Christianity(full form and short form) or the measure of church attendance. The women, however, recordedsignificantly higher scores on the measure of personal prayer.

Table 2 presents the correlation matrix between all four variables. In view of the general lack ofsignificant differences between men and women the two sexes have been analysed together. Thesedata demonstrate a significant relationship between higher levels of self-reported health and amore positive attitude toward Christianity (as measured by both the full form and the short formof the Francis Scale of Attitude toward Christianity), more frequent church attendance, and morefrequent engagement in personal prayer. The measures of religiosity (attitude, prayer and churchattendance) are themselves highly intercorrelated.

Table 3 presents the multiple regression model designed to test two further questions. Thismodel employs the full twenty-four item scale of attitude toward Christianity. Fixed order entryof the predictor variables is used in this model. First, by entering sex into the model as the first

Table 1

Mean scores by sex

Variable Male Female t P<

Mean SD Mean SD

General Health Questionnaire 55.7 14.7 56.6 13.8 )0.5 NS

Attitude toward Christianity (full) 85.5 27.1 90.3 23.8 )1.4 NS

Attitude toward Christianity (short) 24.1 8.5 25.8 7.6 )1.6 NS

Church attendance 3.7 2.3 4.1 2.1 )1.3 NS

Prayer 3.2 1.7 3.6 1.6 )2.0 0.05

Table 2

Correlation matrix

Attitude (short) Attitude (full) Church Prayer

General Health Questionnaire )0.2709 )0.2832 )0.1763 )0.19020.001 0.001 0.05 0.01

Prayer +0.7970 +0.7927 +0.6837

0.001 0.001 0.001

Church +0.7973 +0.7827

0.001 0.001

Table 3

Multiple regression significance tests

Predictor variables r2 Increase b t P<

r2 F P<

Sex 0.0014 0.0014 0.3 NS +0.0566 +0.9 NS

Attitude toward

Christianity

0.0825 0.0811 21.2 0.001 )0.4179 )3.5 0.001

Church attendance 0.0872 0.0047 1.2 NS +0.0981 +1.0 NS

Personal prayer 0.0889 0.0018 0.5 NS +0.0703 +0.7 NS


variable, a check is made for the potential contaminating influence of sex, given the fact thatseparate analyses have not been undertaken for men and women. Second, by entering churchattendance and prayer into the model after entering attitude toward Christianity, it is possible tocheck whether religious behaviour has any additional predictive power over self-reported generalhealth after taking attitude toward Christianity into account. These data demonstrate that higherlevels of self-reported general health are associated with a more positive attitude toward Chris-tianity after taking sex differences into account. These data also demonstrate that attitude towardChristianity is a more powerful predictor of self-reported general health than religious behaviour(as assessed by church attendance and personal prayer) and that these forms of religiousbehaviour convey no additional predictive power in respect of self-reported general health afterattitude toward Christianity has been taken into account.

4. Discussion

The present study set out to test the conclusions advanced by O�Connor et al. (2003) byadministering the General Health Questionnaire, the Francis Scale of Attitude toward Chris-tianity and two behavioural measures of religiosity to a sample of 246 undergraduate students.Two main conclusions have emerged from the present study. The first conclusion is that a morepositive attitude toward Christianity is associated with a higher level of self-reported generalhealth. According to the correlation matrix this finding holds true with assessments based on boththe full form and short form of the Francis Scale of Attitude toward Christianity. This contradictsthe finding of O�Connor et al. (2003). The contradiction may be due to different perspectives indata analysis, or to differences in the samples. Further replication studies are needed to clarify thisissue.

The second conclusion is that differences in attitude toward religion are more important thandifferences in religious behaviour in the prediction of individual differences in self-reported generalhealth. In other words, the attitudinal dimension of religiosity may be a more fundamentaldeterminant of health than religious behaviour. This finding is of significance in shaping boththeory and practice in understanding and managing health enhancement. At a theoretical level,the finding helps to explain the mechanism whereby religiosity may provide a higher level of self-reported general health. This mechanism has more to do with individuals� underlying religiousattitudinal predisposition than with the support which they may receive from public religious


behaviour (churchgoing) or with the support which they may receive from personal religiousbehaviour (prayer). In other words, it is those individuals who, in a Christian or post-Christiancontext, feel themselves to be in a right relationship with God (as indicated by high scores on theattitude scale) who also feel more positive about their own general health. At a practical level, thefinding suggests ways in which religiosity may be a matter of social significance in understandingvariations in levels of self-reported general health across different sectors of the community. Ifreligiosity is a significant predictor of self-assessed general health, it is clearly a mistake to buildmodels of health-related needs without taking religiosity into account. If the attitudinal dimensionof religiosity is key to understanding the link between religion and general health, it is clearly amistake to model this relationship on less efficient indices of affiliation or practice.

These conclusions rest on a study conducted among 246 undergraduate students. The findingsare sufficiently important for the study to deserve replication among other samples in Christianand post-Christian cultural contexts using the General Health Questionnaire alongside theFrancis Scale of Attitude toward Christianity, and in other cultural contexts using the GeneralHealth Questionnaire alongside instruments modelled on the Francis Scale for use within differentfaith contexts, including the Scale of Attitude toward Judaism (see Francis & Katz, 2002), theScale of Attitude toward Islam (see Sahin, 2002; Sahin & Francis, in press), and the Scale ofAttitude toward Hinduism (see Francis, Roshan, Bhanot, & Robbins, under review).

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