The Cross Cultural study of Religiosity and Life Satisfaction Scores (and tying it to autism-related studies)

One of my areas of interest (although not readily apparent from a blog devoted primarily to countering woo sites and providing science-based information regarding autism and therapies to help autistic children) is the function of religious and spiritual beliefs on helping people cope more adaptively and, as a result, experience greater satisfaction with life.

I believe one of the reasons parents/people turn to quack treatments is because they are maladaptively coping. Now, they are certainly using problem-focused coping in the sense that they are trying to solve a problem, but they are doing so in a maladaptive way, while using emotion-focused coping that places them in forums and boards where rather than getting support that would help them cope adaptively, they end up going deeper into woo, pushing each other into a feeding frenzy of increasingly risky treatments. Part of it may be a need to outdo the Joneses, as well, and I've said before that it's likely that a small percentage of these parents have M√ľnchhausen Syndrome by Proxy.

First, some operationalized definitions for you: 

Satisfaction with Life: An internally imposed cognitive judgmental process providing a cumulative score of one’s subjective satisfaction with one’s life (Diener, Emmons, Larson, & Griffin, 1985).

Religious and/or Spiritual Belief Systems: Any metaphysical or life-guiding principles which an individual practices or believes which forms meaning and allows for coping with the difficulties one faces in life. From this vantage, an atheist, an agnostic, an adherent to a traditional religion, or an individual who defines himself as spiritual may all be said to have a religious and/or spiritual belief system. Most studies dealing with this construct may not measure agnosticism or atheism (and indeed may restrict their examination to mainstream religions).

On to the main course, a study that attempts to look at how religiosity and life satisfaction varies across university students from four different cultures:

Dorahy, Lewis, Schumaker, Akuamoah-Boateng, Duze, and Sibiya (1998) compare religiosity scores and life satisfaction scores in four different cultural samples of university students: Ghanaian, Nigerian, Northern Irish, and Swaziland and found that there was not a significant relationship between religiosity and life satisfaction in women in any of the four cultural samples, but a significant relationship between religiosity and men in three of the four groups.

Dorahy et al. (1998) note the number of measurement tools to measure religious beliefs and the variety in potential religious constructs. Part of the difficulty in choosing a measurement tool is reflected in the fact that the psychology of religion remains a fairly contentious and fractured field with little overarching theory to guide it (Paloutzian & Park, 2005), in the difficulty in operationalizing definitions of both religion and spirituality (Miller & Thoreson, 2003), and in the lack of “consistency in the measurement” of religious and spiritual constructs (Rippentrop, 2005, p. 282). Despite the obstacles, a growing body of research points to the importance that religious and spiritual beliefs play in multiple domains (Paloutzian & Park, Miller &Thoreson). For the study, Dorahy et al. chose to use the Theism Sub-Scale of the Religious Attitudes Scale (Maranell, 1974, as cited in Dorahy et al.) to measure their construct of religiosity. This choice was made “in an attempt to provide an alternative measure that would complement those employed by previous studies” (p. 38). The Religious Attitudes Scale does not appear to be a widely used scale in religious and spiritual measurement; no mention is made of it in Hill’s (2005) extensive coverage of available measurement tools which offer good reliability and validity.

The choice to measure life satisfaction was the Satisfaction with Life Scale (SWLS; Diener, Emmons, Larsen, & Griffen, 1985). The SWLS is considered to have moderate concurrent validity, having been compared with nearly a dozen other measures of subjective well-being (Perrone, Webb, Wright, Jackson, & Ksiazak, 2006). Pavot and Diener (1993) found that the SWLS “assesses an individual's conscious evaluative judgment of his or her life by using the person's own criteria” (p. 164).

There appear to be several areas in this study that are open to criticism. Perhaps one of the main issues is the use of only university students for each of the four cultures and the extrapolation that these students, whose mean ages ranged from 22 to 26, represent their culture. Religious affiliations among the four samples varied from 69% to 99% Christian, and no mention is made if the breakdown of religious affiliation corresponds to the population at large. No specific mention is made in the journal article regarding any limitations or potential weaknesses in the study. In addition, Dorahy et al. (1998) used these two scales in the original English, noting that it was “the teaching language at each university” (p. 39). No attempt was made to determine equivalence between the cultures nor was any mention made of a concern regarding equivalence.

While the above criticisms are directed towards cross-cultural issues, a larger problem with the Dorahy et al. (1998) study is that nowhere in the study is religiosity defined, nor how the Theism Sub-Scale in particular is supposed to measure the construct of religiosity.

If I were conducting a similar study today, I would make several adjustments. If I were restricting my sample to university students in four “cultures” I would make it clear that my study was not looking for commonalities among four cultures, but be specific that I was looking at commonalities in university students from four different cultures (I’d also provide some rational as to why the four specific cultures were chosen). I would define clearly the terminology I used; I would pick an assessment tool that was more widely used and would therefore serve as a source of comparison. I would make it clear what the assessment tool was measuring and how (which was not well done for the Theism Sub-Scale; why only that portion, why not the whole scale?). I would look at issues of equivalence and not make a blanket assumption that because English is spoken by all that the terms in the scale are all understood in the same way.

An additional concern I have is the unstated assumption that a person who abstains from belief in god would have less life satisfaction. I would want to look at that specifically. Are atheists really less satisfied? Are agnostics? Are these studies restricted to only believers or are non-believers so off-put by the measurement tool assessing religiosity or religious and spiritual beliefs that they react with hostility? Any study that involves religious and spiritual variables needs to at least consider this, as it may reflect an undetected bias by the researcher. The only scale I have found that measures some component of spirituality which removes “god” from the equation as therefore allows for agnostics and atheists a scale which reduces the chance of a negative reaction is the Spirituality Index of Well-Being (Daaleman & Frey, 2004). I would, if recruiting a sample not restricted to believers, choose this scale.

And now to bring it around to autism and Wakefield (good, ain't I?):

The evidence we gain from studies is only as good as the study design (and subsequent statistical analysis) allows. Flawed study designs leave us no better informed than we were before the study was conducted. Although this particular study doesn't deal with autism, the fact that it is flawed and having demonstrated how it is allows the comparison that many studies related to autism have inherent design flaws within them, which leave us no better informed. The media doesn't look for design flaws or statistical significance, doesn't look at sample size, doesn't look for flaws in analysis, and apparently neither do some of the journals that publish the studies, or Wakefield's mess would have never been published in 1998.


Daaleman, T. P., & Frey, B. B. (2004). The spirituality index of well-being: A new instrument for health-related quality-of-life research. American Family  Medicine 2, 499-503.

Diener, E., Emmons, R., Larsen, R., & Griffin, S. (1985). The Satisfaction With      Life Scale. Journal of Personality Assessment, 49(1), 71-75. Retrieved  January 19, 2008, from Academic Search Premier database.

Dorahy, M., Lewis, C., Schumaker, J., Akuamoah-Boateng, R., Duze, M., &  Sibiya, T. (1998). A cross-cultural analysis of religion and life satisfaction.  Mental Health, Religion & Culture, 1(1), 37. Retrieved December 28, 2007, from Academic Search Premier database.

Hill, P. C. (2005). Measurement in the psychology of religion and spirituality. In R. E. Paloutzian & C. L. Park (Eds.), Handbook of the Psychology of Religion and Spirituality. (pp. 43-61). NY: The Guilford Press.

Miller, W., & Thoresen, C. (2003). Spirituality, religion, and health: An emerging research field. American Psychologist, 58(1), 24-35. Retrieved April 04, 2007, from the PsycARTICLES database.

Paloutzian, R. E., & Park, C. L. (2005). Integrative themes. In R. E. Paloutzian &   C. L. Park (Eds.), Handbook of the Psychology of Religion and Spirituality.  (pp. 3-20). NY: The Guilford Press.

Pavot, W., & Diener, E. (1993). Review of the Satisfaction With Life Scale.             Psychological Assessment, 5(2), 164-172. Retrieved March 15, 2008,  from the PsycARTICLES database.

Perrone, K., Webb, L., Wright, S., Jackson, Z., & Ksiazak, T. (2006). Relationship of spirituality to work and family roles and life satisfaction among gifted adults. Journal of Mental Health Counseling, 28(3), 253-268. Retrieved   December 8, 2007, from Academic Search Premier database.

Rippentrop, A. (2005). A review of the role of religion and spirituality in  chronic pain populations. Rehabilitation Psychology, 50(3), 278-284. Retrieved September 14, 2007, from PsycARTICLES database.


kathleen said...

Excellent points. There is much to be explored with this topic.
I have always thought that in some places autism could be compared with any extremist religion. Where life right now doesn't matter-it is the "after life" that people are working for. It makes you wonder if there is any satisfaction with life at all.

David said...

A couple thoughts I have had about "Munchausen by proxy". First, I see no reason to doubt that "Munchausen tendencies" can exist with as well as without a real health problem. The foreseeable result is a "gray zone" of parents whose children are genuinely ill, but who either act to aggravate the condition,or pursue "cures" in a manner that is obsessive and more likely to do further harm. Second, I doubt very much whether the child can be considered a passive "victim". If the situation continues over an extended period of time, it is probable that the child is, to some extent, playing along to satisfy the parent.

kathleen said...

You doubt whether or not a child can be a passive victim??? So you're saying that if a parent spends a large part of a child's life telling them how sick they are-the child will somehow realize this is not true-but go along to please the parent? In the case of autism..a parent convinced that there child is non verbal because of heavy metal poisoning and subjects them to I.V. chelation...for years..are you suggesting the child is choosing to be non verbal? How about a child whose parents are convinced that lupron or chemical castration is the only way to deal with aggression-are you saying that in order to please their parents a child will continue aggressive behavior on purpose-in order to placate their parents? Kind of like an accomplice?
Munchausen by proxy is child abuse. Even if a child figured out that something is not quite right with their parent-they are victims. There is no grey area there.

KWombles said...

I think it's possible that a small percentage of these more obsessive parents who can be found relating what seems like a never-ending list of treatments they have attempted to cure their child may indeed have Munchausen by proxy.

The literature on Munchausen and Munchausen by proxy does indeed note that there are some cases where older children have engaged in the mother's fictional complaints in order to please the parent. I would argue they are not active victims or willing participants, even if there is behavior intentionally engaged in.

There are teens who develop Munchausen after having been victims of their parent's Munchausen by proxy (Schreier, 2002). They remain abuse victims, though, and any language that might implicate them as accomplices in their abuse should be avoided.

Even with those acknowledgments of the literature, I think suggesting that autistic children would and could go along with their parents is another matter entirely, and one that is dangerously close to blaming the victim. If you've been raised to see yourself as ill, you wil see yourself that way; you will be far more likely to react to every somatic complaint as if it demonstrates that state of being ill. The damage parents in these situations can and do cause, both physiologically and psychologically is tremendous. In no way should we lessen that damage with the suggestion that the victim is a willing participant in the endeavor.

Schreier, H. (2002). Munchausen by Proxy Defined. Pediatrics, 110(5), 985. Retrieved from Psychology and Behavioral Sciences Collection database

David said...

Just to clarify, I do NOT see the situation I describe as lessening the responsibility of the parent. On considering that issue, I find it similar to the tricky problem of whether to "blame" a victim of domestic violence for not leaving her partner. But, much of the difficulty is removed by the facts that a) a child has known no other environment and b) may not really understand the situation.