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Maintaining healthy behaviors is challenging. Based upon previous reports that in North Carolina (NC), USA, overweight/obese clergy lost weight during a two-year religiously tailored health intervention, we described trajectories of diet, physical activity, and sleep. We investigated whether behavior changes were associated with weight and use of health-promoting theological messages. Improvements were observed in sleep, calorie-dense food intake, and physical activity, with the latter two associated with weight loss. While theological messages were well-retained, their relationship with behaviors depended on the specific message, behavior, and timing. Findings offer insights into weight loss mechanisms, including the role of theological messages in religiously tailored health interventions., (© 2023. The Author(s).)

As an occupational group, clergy exhibit numerous physical health problems. Given the physical health problems faced by clergy, understanding where physical health falls within the priorities of seminary students, the ways students conceptualize physical health, and how seminary students do or do not attend to their physical health in the years immediately prior to becoming clergy, can inform intervention development for both seminary students and clergy. Moreover, understanding and shaping the health practices of aspiring clergy may be particularly impactful, with cascading effects, as clergy serve as important role models for their congregants. Drawing on 36 in-depth, qualitative interviews with first-year seminary students, this study examines the complex dynamics between religious frameworks related to physical health, explicit intentions to maintain healthy practices, and reported physical health behaviors. Our findings suggest that even students who deploy religious frameworks in relation to their physical health-and who, as a result, possess positive intentions to implement and maintain healthy behaviors-often report being unable to live up to their aspirations, especially in the face of barriers to health practices posed by the seminary program itself. After reviewing these findings, we offer suggestions for physical health focused interventions, including action and coping planning, which could be implemented at seminaries to reduce the intention-behavior gap and improve clergy health., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Like many helping professionals in emotional labor occupations, clergy experience high rates of mental and physical comorbidities. Regular stress management practices may reduce stress-related symptoms and morbidity, but more research is needed into what practices can be reliably included in busy lifestyles and practiced at a high enough level to meaningfully reduce stress symptoms., Methods and Analysis: The overall design is a preference-based randomized waitlist control trial. United Methodist clergy in North Carolina will be eligible to participate. The intervention and waitlist control groups will be recruited by email. The interventions offered are specifically targeted to clergy preference and include mindfulness-based stress reduction, Daily Examen, and stress inoculation training. Surveys will be conducted at 0, 12, and 24 weeks with heart rate data collected at 0 and 12 weeks. The primary outcomes for this study are self-reported symptoms of stress and heart rate at week 12 for each intervention compared to waitlist control; the secondary outcome is symptoms of anxiety comparing each intervention vs waitlist control., Ethics and Dissemination: Ethical approval was obtained from the Duke University Campus IRB (2019-0238). The results will be made available to researchers, funders, and members of the clergy community., Strengths and Limitations of This Study: While evidence-based stress reduction practices such as mindfulness-based stress reduction (MBSR) exist, a wider variety of practices should be tested to appeal to different individuals. Clergy in particular may prefer, and consequently enact, spiritual practices like the Daily Examen, and individuals such as clergy who spend most of their time thinking and feeling may prefer experiential-based practices like stress inoculation training. If efficacious, the Daily Examen and stress inoculation training practices have high feasibility in that they require few minutes per day. This study is limited by the inclusion of Christian clergy of only one denomination., Trial Registration: ClinicalTrials.gov NCT04625777 . November 12, 2020., (© 2021. The Author(s).)

Clergy provide significant support to their congregants, sometimes at a cost to their mental health. Identifying the factors that enable clergy to flourish in the face of such occupational stressors can inform prevention and intervention efforts to support their well-being. In particular, more research is needed on positive mental health and not only mental health problems. We conducted interviews with 52 clergy to understand the behaviors and attitudes associated with positive mental health in this population. Our consensual grounded theory analytic approach yielded five factors that appear to distinguish clergy with better versus worse mental health. They were: (1) being intentional about health; (2) a "participating in God's work" orientation to ministry; (3) boundary-setting; (4) lack of boundaries; and (5) ongoing stressors. These findings point to concrete steps that can be taken by clergy and those who care about them to promote their well-being.

Religious participation and spirituality are linked to good mental health. However, clergy may experience more depression than is observed in the general population, which may be due in part to high job strain. The objectives of this study were to identify distinct longitudinal trajectories of depressive symptoms in clergy and to identify variables associated with each course. The sample was 1172 clergy who were followed for up to 66 months. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-8), which was administered approximately every 6 months. Latent class trajectory analysis was conducted for group identification, and a 3-class trajectory model fit the data best. Class 1 (38% of the sample) had minimal or no depressive symptoms over time, class 2 (47%) had chronic mild symptoms, and class 3 (15%) had persistent moderate/severe symptoms. Occupational distress was significantly associated with trajectory class. The odds of being in either the chronic mild or the persistent moderate/severe depressive symptom class were significantly higher for those who were female, for those with fair/poor self-rated health, for those with more perceived financial or occupational stress, for those with lower levels of perceived emotional support, and/or for those with lower levels of spiritual well-being. The class exhibiting resilience to depressive symptoms had higher levels of perceived support and spiritual well-being as well as lower levels of perceived financial and occupational stress. A substantial percentage of clergy, and possibly people in similar helping occupations, may experience significant levels of depressive symptoms that do not remit over time. These individuals may benefit from treatments that address work-related coping.

Aim: Sophisticated adjustments for socioeconomic status (SES) in health disparities research may help illuminate the independent role of race in health differences between Blacks and Whites. In this study of people who share the same occupation (United Methodist Church clergy) and state of residence (North Carolina), we employed naturalistic and statistical matching to estimate the association between race-above and beyond present SES and other potential confounds-and health disparities., Methods: We compared the health of 1414 White and 93 Black clergy. Then, we used propensity scores to match Black and White participants on key socioeconomic, demographic, occupational, and physical activity characteristics and re-examined differences in health., Results: Prior to propensity score matching, Black clergy reported worse physical health than their White counterparts. They had greater body mass index, higher prevalence of diabetes and hypertension, and lower physical health functioning. White clergy reported less favorable mental health. They had higher severity of depression and anxiety symptoms as well as lower quality of life and mental health functioning. Propensity score analysis revealed that matching on SES and other key variables accounted for most, but not all, of the observed racial differences. Racial disparities in hypertension, depression severity, and mental health functioning persisted despite adjustments., Conclusions: Race contributed to health disparities in some outcomes in our study population, above and beyond our measures of participants' present SES and key demographic, occupational, and physical activity variables. This study provides evidence supporting the position that race contributes to health disparities through pathways other than SES.

Background: Metabolic syndrome (Met-S) has a robust concurrent association with depression. A small, methodologically limited literature suggests that Met-S and depression are reciprocally related over time, an association that could contribute to their overlapping influences on morbidity and mortality in cardiovascular disease, diabetes, and cancer., Purpose: Using a refined approach to the measurement of Met-S as a continuous latent variable comprising continuous components, this study tested the prospective associations between Met-S and depression., Methods: This study of 1114 clergy included four annual assessments of depressive symptoms and Met-S components. Standard methods were used to measure Met-S risk factors, and the Patient Health Questionnaire-8 was used to assess depressive symptoms. We used confirmatory factor analysis to verify the structure of Met-S and depression and structural equation modeling to quantify the prospective relationships., Results: The statistical models confirmed the validity of quantifying Met-S as a continuous latent variable, replicated previous evidence of a concurrent association, and indicated a significant prospective association of initial depressive symptoms with subsequent Met-S. Initial Met-S was at most only weakly associated with subsequent depressive symptoms, and the former prospective effect was significantly larger. Associations of depressive symptoms and Met-S were significant for both men and women, but somewhat stronger among men., Conclusions: Results support representation of Met-S as a continuous latent variable. The association of initial depressive symptoms with later Met-S suggests that interventions addressing these correlated risk factors may prove useful in preventive efforts.

As community leaders, clergy are well-positioned to impact the health of their congregants. Clergy's conceptualizations of health influence their own self-care and how they minister to others. Interviews and focus group discussions on health conceptualizations and health-seeking behaviors were conducted with 49 United Methodist Church clergy in Western Kenya. Data were analyzed using interpretative phenomenological methods. Participants defined health holistically using an environmental health model. Some participants reported not seeking health care so their congregants would believe that their faith kept them healthy. Participants who believed that health comes directly from God reported seeking health care less often. Participants also reported combining traditional indigenous medicine with Western medicine. This study has implications for health promotion among Kenyan clergy and offers the first study of health conceptualization among clergy in Africa.

Measuring spiritual well-being among clergy is particularly important given the high relevance of God to their lives, and yet its measurement is prone to problems such as ceiling effects and conflating religious behaviors with spiritual well-being. To create a measure of closeness to God for Christian clergy, we tested survey items at two time points with 1,513 United Methodist Church clergy. The confirmatory factor analysis indicated support for two, six-item factors: Presence and Power of God in Daily Life, and Presence and Power of God in Ministry. The data supported the predictive and concurrent validity of the two factors and evidenced high reliabilities without ceiling effects. This Clergy Spiritual Well-being Scale may be useful to elucidate the relationship among dimensions of health and well-being in clergy populations.

The clergy occupation is unique in its combination of role strains and higher calling, putting clergy mental health at risk. We surveyed all United Methodist clergy in North Carolina, and 95% (n = 1,726) responded, with 38% responding via phone interview. We compared clergy phone interview depression rates, assessed using the Patient Health Questionnaire (PHQ-9), to those of in-person interviews in a representative United States sample that also used the PHQ-9. The clergy depression prevalence was 8.7%, significantly higher than the 5.5% rate of the national sample. We used logistic regression to explain depression, and also anxiety, assessed using the Hospital Anxiety and Depression Scale. As hypothesized by effort-reward imbalance theory, several extrinsic demands (job stress, life unpredictability) and intrinsic demands (guilt about not doing enough work, doubting one's call to ministry) significantly predicted depression and anxiety, as did rewards such as ministry satisfaction and lack of financial stress. The high rate of clergy depression signals the need for preventive policies and programs for clergy. The extrinsic and intrinsic demands and rewards suggest specific actions to improve clergy mental health.

Clergy suffer from high rates of obesity, chronic disease, and depression, and simultaneously underestimate the toll these take on their daily functioning. Health interventions are needed for clergy and may be tailored to their occupational context and theological beliefs. Few studies have sought to improve clergy health. No prior studies have utilized a randomized design. Spirited Life is a randomized, multiple baseline study that offered enrollment to nearly all United Methodist Church clergy in North Carolina in fall 2010. A total of 1114 clergy (response rate = 64%) enrolled. Using a multiple baseline design, we randomized participants to three cohorts. Each cohort began the health intervention in one of three consecutive years. The third cohort served as a randomized waitlist control cohort, allowing comparisons between the first and third cohorts. The two-year Spirited Life intervention consists of: 1) a theological underpinning for health stewardship based on incarnation, grace, and response and delivered during workshops; 2) the stress management program Williams LifeSkills; 3) Naturally Slim, an online weight loss program; 4) phone contact with a Wellness Advocate; and 5) $500 small grants for health goals. Metabolic syndrome is the primary endpoint. Stress and depressive severity are secondary endpoints. We measured each construct before, twice during, and at the end of the two-year intervention. Study outcomes, to be published after follow-up data are gathered, will provide evidence of the effectiveness of the combined intervention components of Spirited Life. If successful, the intervention may be considered for use with other clergy and faith populations., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Clergy suffer from chronic disease rates that are higher than those of non-clergy. Health interventions for clergy are needed, and some exist, although none to date have been described in the literature. Life of Leaders is a clergy health intervention designed with particular attention to the lifestyle and beliefs of United Methodist clergy, directed by Methodist LeBonheur Healthcare Center of Excellence in Faith and Health. It consists of a two-day retreat of a comprehensive executive physical and leadership development process. Its guiding principles include a focus on personal assets, multi-disciplinary, integrated care, and an emphasis on the contexts of ministry for the poor and community leadership. Consistent with calls to intervene on clergy health across multiple ecological levels, Life of Leaders intervenes at the individual and interpersonal levels, with potential for congregational and religious denominational change. Persons wishing to improve the health of clergy may wish to implement Life of Leaders or borrow from its guiding principles.

United Methodist clergy have been found to have higher than average self-reported rates of obesity, diabetes, asthma, arthritis, and high blood pressure. However, health diagnoses differ from physical health functioning, which indicates how much health problems interfere with activities of daily living. Ninety-five percent (n = 1726) of all actively serving United Methodist clergy in North Carolina completed the SF-12, a measure of physical health functioning that has US norms based on self-administered survey data. Sixty-two percent (n = 1074) of our sample completed the SF-12 by self-administered formats. We used mean difference tests among self-administered clergy surveys to compare the clergy SF-12 Physical Composite Scores to US-normed scores. Clergy reported significantly better physical health composite scores than their gender- and age-matched peers, despite above average disease burden in the same sample. Although health interventions tailored to clergy that address chronic disease are urgently needed, it may be difficult to elicit participation given pastors' optimistic view of their physical health functioning.

Culturally competent health interventions require an understanding of the population's beliefs and the pressures they experience. Research to date on the health-related beliefs and experiences of clergy lacks a comprehensive data-driven model of clergy health. Eleven focus groups with 59 United Methodist Church (UMC) pastors and 29 UMC District Superintendents were conducted in 2008. Participants discussed their conceptualization of health and barriers to, and facilitators of, health promotion. Audiotape transcriptions were coded by two people each and analyzed using grounded theory methodology. A model of health for UMC clergy is proposed that categorizes 42 moderators of health into each of five levels drawn from the Socioecological Framework: Intrapersonal, Interpersonal, Congregational, United Methodist Institutional, and Civic Community. Clergy health is mediated by stress and self-care and coping practices. Implications for future research and clergy health interventions are discussed.

We used self-reported data from United Methodist clergy to assess the prevalence of obesity and having ever been told certain chronic disease diagnoses. Of all actively serving United Methodist clergy in North Carolina (NC) 95% (n = 1726) completed self-report height and weight items and diagnosis questions from the Behavioral Risk Factor Surveillance Survey (BRFSS). We calculated BMI categories and diagnosis prevalence rates for the clergy and compared them to the NC population using BRFSS data. The obesity rate among clergy aged 35-64 years was 39.7%, 10.3% (95% CI = 8.5%, 12.1%) higher than their NC counterparts. Clergy also reported significantly higher rates of having ever been given diagnoses of diabetes, arthritis, high blood pressure, angina, and asthma compared to their NC peers. Health interventions that address obesity and chronic disease among clergy are urgently needed.

Weight-loss maintenance is essential to sustain the health benefits of weight loss. Studies with lower intensity intervention supports under real-world conditions are lacking. This study examined changes in weight and cardiometabolic biomarkers among Spirited Life participants following initial 12-month weight loss at 12–24 months and 24–42 months. A total of 719 clergy received a wellness intervention, including a 10-week online weight-loss program in the first 12 months and monthly health coaching throughout 24 months. Mean changes in weight, blood pressure, high-density lipoproteins, and triglycerides were estimated using random effects linear models, accounting for repeated measures. Weight was additionally analyzed in subsamples stratified by body mass index (BMI). At baseline, 17.1% of participants had BMI < 25 kg/m2 and 11.8% had BMI ≥ 40 kg/m2. Mean 12-month weight loss was −2.4 kg (95% CI: −2.8 kg, −2.1 kg). On average, at 42 months, participants regained weight but did not exceed baseline (−0.5 kg, 95% CI: −1.2 kg, 0.2 kg), improvements in triglycerides were completely sustained (−13.9 mg/dL, 95% CI: −18.6 mg/dL, −9.2 mg/dL), and systolic blood pressure improvements remained significant (−1.9 mmHg, 95% CI: −3.0 mmHg, −0.9 mmHg). Participants with a BMI ≥ 40 kg/m2 lost significantly more weight that was sustained at 42 months (−5.8 kg, 95% CI: −8.9 kg, −2.7 kg). The Spirited Life wellness intervention produced weight loss and, for participants with higher levels of obesity, sustained weight-loss maintenance. The intervention was effective for long-term prevention of weight gain among participants with BMI of 25 to ≤40 kg/m2, through 42 months. Wellness interventions such as Spirited Life should be considered for adoption. [ABSTRACT FROM AUTHOR]

We argue that perceived support is best conceptualized more as a measure of how an individual appraises his/her situation rather than a true reflection of how much support he/she receives. To test this theory, we used survey data from the Clergy Health Initiative Panel Survey to examine the relationship between perceived and received social support and their association with depressive symptoms in clergy (N = 1,288). Overall, analyses revealed perceived support had a weak association with received support. Greater perceived support had a significant relationship with lower depressive symptoms. In contrast, greater received support had only a small relationship with lower depressive symptoms, which was fully mediated by perceived support. Our results raise questions about the effectiveness of many clergy social support interventions, which often aim to boost the quality and/or quantity of received social support. We suggest it may be more advantageous to boost perceptions of social support, possibly through cognitive reframing or positive mental health interventions. [ABSTRACT FROM AUTHOR]

Clergy fulfill vital societal functions as meaning makers and community builders. Partly because of their important roles, clergy frequently encounter stressful situations. Further, studies suggest that clergy experience high rates of depression. Despite this, few studies have examined protective factors for clergy that may increase their positive mental health. We invited all United Methodist clergy in North Carolina to participate in a survey. Of church-serving clergy, 85 percent responded ( n = 1,476). Hierarchical multiple regression was used to assess the predictors of three positive and four negative mental health outcomes. The three sets of predictors were: demographics, which explained 2-10 percent of the variances; variables typically related to mental health (social support, social isolation, and financial stress), which explained 14-41 percent of the variances; and clergy-specific variables, which explained 14-20 percent of the variances, indicating the importance of measuring occupation-specific variables. Some variables (e.g., congregation demands) significantly related to both positive and negative mental health, whereas others (e.g., positive congregations, congregation support) significantly related primarily to positive mental health. In addition to their intervention implications, these findings support separate consideration for negative versus positive mental health. [ABSTRACT FROM AUTHOR]

With data from the Clergy Health Initiative Longitudinal Survey, we look for interviewer effects, differences between web and telephone delivery, and panel conditioning bias in an “important matters” name generator and interpreter, replicated from the U.S. General Social Survey. We find evidence of phone interviewers systematically influencing the number of confidants named, we observe that respondents assigned to the web survey reported a larger number of confidants, and we uncover strong support for panel conditioning. We discuss the possible mechanisms behind these observations and conclude with a brief discussion of the implications of our findings for similar studies. [ABSTRACT FROM AUTHOR]

The most commonly used self-report stress measure is the ten-item Perceived Stress Scale (PSS), first published by Cohen in 1983. The pss seeks to measure one's appraisal of stress, helplessness and self-efficacy. We determined how Christian clergy might respond to the pss by conducting cognitive interview testing with a sample of twelve United Methodist pastors. Interviews were audiotaped and summarized, with content analysis conducted on the summaries. Data saturation was achieved. Participants reported strong negative reactions to pss language like 'upset' and 'angered'. Although the pss considers higher perceived control to be indicative of less stress, participants reported that they consider accepting lack of control as a sign of faith. Participants reported fears of being poorly regarded as religious leaders upon endorsing items like lack of ability to 'handle personal problems'. Participants indicated that their theological beliefs of seeking God's way and being faithful conflicted with items such as 'things are going your way' and 'you could not overcome'. When answered by Christian pastors, the majority of pss items may be subject to under-reporting and response bias. Future research should identify valid stress measures for Christian clergy and assess the validity of the pss in non-clergy Christian populations. [ABSTRACT FROM AUTHOR]

Clergy often face a great deal of occupational stress that in turn can lead to psychological distress. In recent years, denominations have been turning to peer support groups to combat these challenges, but little research exists regarding their effectiveness. This study explores the utility of peer support groups for reducing psychological distress among pastors by analyzing data from two waves of an ongoing study of United Methodist Church (UMC) clergy in North Carolina, as well as focus group data from the same population. Results indicate that participation in peer support groups had weakly beneficial direct and indirect relationships to psychological distress (measured as mentally unhealthy days, anxiety, and depression). Focus group data indicated that the weak results may be due to an interplay between varied group activities and differences in individual coping styles, which in turn lead to a mix of positive and negative group experiences. The results caution against assuming that peer groups are a uniformly effective solution to the occupational demands of pastoral work. [ABSTRACT FROM PUBLISHER]

Research indicating high rates of chronic disease among some clergy groups highlights the need for health programming for clergy. Like any group united by similar beliefs and norms, clergy may find culturally tailored health programming more accessible and effective. There is an absence of research on what aspects clergy find important for clergy health programs. We conducted 11 focus groups with United Methodist Church pastors and district superintendents. Participants answered open-ended questions about clergy health program desires and ranked program priorities from a list of 13 possible programs. Pastors prioritized health club memberships, retreats, personal trainers, mental health counseling, and spiritual direction. District superintendents prioritized for pastors: physical exams, peer support groups, health coaching, retreats, health club memberships, and mental health counseling. District superintendents prioritized for themselves: physical exams, personal trainers, health coaching, retreats, and nutritionists. Additionally, through qualitative analysis, nine themes emerged concerning health and health programs: (a) clergy defined health holistically, and they expressed a desire for (b) schedule flexibility, (c) accessibility in rural areas, (d) low cost programs, (e) institutional support, (f) education on physical health, and (g) the opportunity to work on their health in connection with others. They also expressed concern about (h) mental health stigma and spoke about (i) the tension between prioritizing healthy behaviors and fulfilling vocational responsibilities. The design of future clergy health programming should consider these themes and the priorities clergy identified for health programming. [ABSTRACT FROM AUTHOR]

The article focuses on clergy health, while referring to the history and present, which is deteriorating due to their stressful life. Four categories of proposed clergy stressors include vocational, intrapersonal, family and social stressors. Research also stated that clergy lived more than white-collar professionals. The article also introduces the current issue of the journal on articles with topics including emotional well-being, sexual health and physical health.

COVID-19 and its associated restrictions presented unprecedented challenges for those in the helping professions. In this study, we seek to understand how the mental health of those who belong to one specific helping profession – clergy – changed in the context of COVID-19. Using longitudinal data of a sample of United Methodist pastors from the North Carolina Clergy Health Initiative, we conduct both cross-sectional and person-centered analyses to investigate how the overall mental health of this occupational group changed, as well as how different subgroups of clergy fared within the context of the pandemic, depending on their well-being prior to the onset of COVID-19. We found that the mental health of pastors suffered within the context of the pandemic, but that individual changes in mental health differed based on what the combined positive and negative mental health patterns of clergy were prior to the pandemic, for which we used latent class analysis to identify as Flourishing, Distressed, Languishing, or Burdened but Fulfilled. Of these subgroups, having Flourishing pre-pandemic status was protective of mental health following the onset of COVID-19, whereas the other three subgroups' mental health statuses worsened. This study is the one of the first longitudinal studies of helping professionals which has tracked changes in mental health before and after the onset of COVID-19. Our findings demonstrate the utility of considering positive and negative mental health indicators together, and they point to certain groups that can be targeted with well-being resources during future periods of acute or abnormal stress. • 4 subgroups of positive and negative mental health patterns identified among clergy. • Pastors experienced increases in depression, anxiety, and burnout during COVID-19. • Individual changes in clergy mental health depend on pre-pandemic mental health. [ABSTRACT FROM AUTHOR]

This paper investigates the mental health promotion and protection (MHPP) model of reducing depression. Data are from the Clergy Health Initiative Longitudinal Survey of United Methodist ministers in North Carolina that included the Mental Health Continuum Short Form (MHC-SF) for positive mental health and the Patient Health Questionnaire (PHQ-9) for depression in 2014 and 2016 (N = 955). The promotion hypothesis predicts reduced risk of depression in 2016 among clergy whose mental health increased to flourishing and the increased risk of depression in 2016 for clergy who stayed not flourishing. The protection hypothesis predicts increased risk of depression in 2016 for clergy who were flourishing in 2014 but went down to 'not flourishing' in 2016. The reference group is clergy who stayed flourishing. We used modified Poisson regression models for binary outcomes to estimate Prevalence Ratios (PR) and to estimate Incidence Rate Ratios (IRR) of depression in 2016 associated with changes in mental health status. Results support both hypotheses. Compared to clergy who stayed flourishing, clergy who improved to flourishing were as likely, while clergy who stayed not flourishing were nearly seven times more likely, to have depression in 2016. Clergy who declined to not flourishing were six times more likely to have depression in 2016 compared to those who stayed flourishing. Similar patterns were observed when the sample was restricted to clergy without depression in 2014. These findings suggest focusing on MHPP as a complementary approach to treatment to reduce the incidence, prevalence and burden of depression. [ABSTRACT FROM AUTHOR]