Are Spiritual Well-Being and Social Support One and the Same?

Research determines the correlation between spirituality and social support.

Posted Jan 25, 2021

When coping with hardship, spiritual beliefs and the support of others are two beneficial mechanisms that lead to resiliency and breakthroughs. In this interview, Glen Milstein demonstrates their correlation and whether spiritual well-being's positive effect on its outcomes is different than social support.

Glen Milstein, used with permission
Source: Glen Milstein, used with permission

Glen Milstein is an associate professor in Psychology at The City College of The City University of New York. He received his Ph.D. in Clinical Psychology from Columbia University with training at the Bellevue Hospital Center and an NIMH post-doctoral fellowship at the Weill Medical College of Cornell University.  The foundation of Dr. Milstein's work with his colleagues is the lifespan development of beliefs: Since humans are born without a word or a prayer, Glen is interested in how the language(s) of religion(s) becomes us through our families, friends, partners, and communities. 

In 2019, he guest-edited a section on Religion and Spirituality in the Context of Disaster for the journal Psychological Trauma: Theory, Research, Practice, and Policy. In 2020, he co-edited an issue on Religion and Health for the Journal of Prevention & Intervention in the Community. He is currently part of a task force within the American Psychological Association that is collaborating on a document to provide religious and spiritual competency practice guidelines for psychologists.

This is Part 1 of a two-part interview with Dr. Glen Milstein; you can find Part 2 of this series here.

Jamie Aten: How did you first get interested in this topic?

Glen Milstein: I came to study religion through a search for what is human. As an undergraduate, I spent a year in Jerusalem, learning in-depth the Jewish texts of my family’s traditions while also witnessing the varieties of religious expression. That year I was present amid the contiguous prayers of different Christian denominations in the Church of the Holy Sepulchre on Easter. 

Over the years, I continued to witness religions in multiple cultures. In Egypt and Turkey, I learned of doctrinal divisions, as well as central pillars that unite Islam. I witnessed holy Hindu rites in Varanasi, India, and saw Buddhist prayers engraved into stones in Nepal, next to spinning prayer wheels, below multi-colored prayer flags flapped by the wind. For close to three years, I was a Peace Corps volunteer in a small village in the Dominican Republic with nine different churches. In my search for what is unique to humanity, I found the ubiquity of religion.

As a research assistant for Peter Guarnaccia, Ph.D.—a psychiatric anthropologist—I listened to a mother of a person with schizophrenia answer our question about whether she thought her son’s illness would ever be cured. She responded, “Si Dios hace la obra, el se va a sanar, aunque los doctores digan que el va a ser así siempre. (If God performs the deed, he will get well, even though the doctors say he will always be like this.).” I knew this was less a rejection of psychiatry than a breakdown of understanding. The medical model of schizophrenia does not have the vocabulary necessary to find more cogent and empathic ways to engage this parent whose strength to care is sustained through her faith. Through a decade of work in psychiatric hospitals, I saw the tenacity of religious belief both help persons to cope, as well as at times impede clinical care.

All these experiences motivated me—along with Chaplain Amy Manierre, M.Div., MSW—to build the model for Clergy Outreach and Professional Engagement (COPE), in order to recognize the borders between lived religion and clinical science, as well as to bridge these borders through collaborations in the service of sustained wellness, care, and recovery. That has at times meant teaching clergy that mental illness is “real” while also reminding psychologists that religion is “real.”  

JA: What was the focus of your study?

GM: This paper is one of 35 research articles (and counting) that have been written by the Duke Clergy Health Initiative (CHI) led by Rae Jean Proeschold-Bell, Ph.D. CHI is a long-term program of assessment and intervention development, sponsored by The Duke Endowment to improve the working lives of North Carolina’s United Methodist ministers. The work has implications for other clergy and for everyone challenged with work/life/family balance.

In the lives of the clergy followed by CHI, I saw an opportunity to study a core question in psychology about the reality of religion. Some have argued that religion is a proxy for social support. They argue that when we measure people’s spiritual well-being and find it to be predictive of positive and negative outcomes, we are really measuring perceived social support. 

I wondered if spiritual well-being, and its relationship with outcomes, was distinct from social support. This view posed multiple challenges. First, how do you compare the effects of social support and religion: How could one determine if “religion” has an influence on persons’ lives, independent of social support? Second, given the developmental plasticity of religion—its many forms across the lifespan—how do you find a vocabulary that will specifically measure religion in the lives of the individuals you study? 

CHI—in working with Methodist ministers—had developed a measure which asked these clergy about the “Presence and Power of God” in their lives. This phrase has a personal—and emic—resonance with their Protestant Christian theology. They were asked about this in their everyday lives as well as their ministry, providing two measures of spiritual well-being. 

In collaboration with Celia Hybels, Ph.D., we compared the longitudinal relationships of social support, spiritual well-being, depressive symptoms, and occupational distress for 895 United Methodist clergy. Would they be correlated with one another when initially measured? How would they predict each other one year later?  

JA: What did you discover in your study?

GM: As expected at Time 1, the higher one’s spiritual well-being, the lower one’s depressive symptoms and occupational distress. Also, at Time 1, higher depressive symptoms were associated with higher occupational distress. We wondered if these same relationships would hold and would they be reciprocal, above and beyond social support, when we looked at longitudinal changes between Time 1 and Time 2 (1 year later).

We found that this did not happen consistently. Neither occupational distress nor depressive symptoms predicted spiritual well-being one year later. Occupational distress also did not predict depressive symptoms. What we did discover is that higher depressive symptoms at Time 1 predicted higher levels of occupational distress one year later. We also found the inverse for spiritual well-being, which, when it was higher at Time 1, predicted lower depressive symptoms one year later. 

We also were able to empirically demonstrate that the effects of spiritual well-being were not a proxy for social support in these analyses. Rather, these specifically religious thoughts and feelings independently predicted depressive symptoms. 

JA: Is there anything that surprised you in your findings or that you weren't fully expecting?

GM: This study exemplifies why we do empirical psychological research of religion, including statistical analyses. Because we were able to follow nearly 900 people over time, their answers to the same questions a year apart provided data to support that spiritual well-being had an association with depressive symptoms independent of social support.  

We were surprised to find that neither ministers’ depressive symptoms nor occupational distress predicted spiritual well-being a year later, although the converse was true in that higher levels of spiritual well-being predicted lower levels of future depressive symptoms. We found that depressive symptoms were predictive of future occupational distress but then were surprised that occupational distress was not predictive of future depression. Our study demonstrated that spiritual well-being may be protective against future depressive symptoms and that reducing or keeping depressive symptoms low may prevent future occupational distress.

Read Part 2 of this series.


Milstein, G., Hybels, C. F., & Proeschold-Bell, R. J. (2020). A prospective study of clergy spiritual well-being, depressive symptoms, and occupational distress. Psychology of Religion and Spirituality, 12(4), 409-416. doi:10.1037/rel0000252