Black Church Leaders’ Attitudes

about Seeking Mental Health Services:

Role of Religiosity and Spirituality
Elizabeth Okunrounmu, Drexel University, USA
Argie Allen-Wilson, Drexel University, USA
Maureen Davey, Drexel University, USA
Adam Davey, Temple University, USA

Abstract: Black church leaders are often first responders to mental health issues in the African American community, yet
few have examined their views. We surveyed 112 church leaders in a Baptist Black mega-church (twenty-two associate
pastors, thirty-four deacons, and fifty-six congregation care givers) using the National Survey of American Life to
examine how religiosity is associated with attitudes about seeking mental health services. Church leaders who were more
religious and who reported attending church more often tended to not seek out formal mental health services. Clinical
providers and Black churches should develop collaborative partnerships to better meet the needs of this community.

Keywords: African American, Church Leaders, Mental Health Services, Religiosity, Spirituality

Introduction

P rior research suggests religious African Americans tend to less often seek out formal
mental health services when needed (Colbert et al. 2009; Payne 2009; Stansbury 2011).
Given the centrality of the Black church among many African Americans, church leaders
are often first responders to mental health issues who facilitate making referrals to formal mental
health services (Neighbors et al. 1998; Oppenheimer et al. 2004; Payne 2009). Yet few
researchers have examined associations between levels of religiosity and Black church leaders’
attitudes about seeking outside mental health services (Conner et al. 2010; Mishra et al. 2009;
Neighbors et al. 1998). In order to fill this gap, we examined 112 church leaders’ attitudes about
seeking outside mental health services in one northeastern urban Baptist African American
mega-church (three nested levels of leadership: twenty-two associate pastors, thirty-four deacons,
and fifty-six congregational caregivers). The primary aim of our cross-sectional self-reported
survey study was to examine how church leaders’ levels of spirituality and religiosity are
associated with the following outcomes of interest: 1) any personal use of mental health care
services and 2) overall self-reported physical and mental health.

Mental Health Disparities

It has been estimated that approximately 57.5 million American adults will experience at least
one mental health issue each year (Kessler et al. 2005; Williams et al. 2007). Although mental
health issues affect individuals across all races, ages, ethnicities, and genders, some groups tend
to experience mental health disparities (Davis and Sondheimer 2005). Compared to their White
counterparts, African Americans have higher rates of depression, post-traumatic stress disorder,
and dual diagnoses and have lower rates of utilizing outpatient mental health services (Davey et
al. 2008; Jackson et al. 2004; Snowden 2001; Ward et al. 2009; Williams et al. 2007). Prior
studies suggest African Americans are more often diagnosed with depression and physical
illnesses (Schnittker et al. 2005; Snowden 2001). Researchers who examined rates of depression

The International Journal of Religion and Spirituality in Society

Volume 6, Issue 4, 2016, www.religioninsociety.com
© Common Ground Publishing, Elizabeth Okunrounmu, Argie Allen-Wilson,
Maureen Davey, Adam Davey, All Rights Reserved
Permissions: cg-support@commongroundpublishing.com
ISSN: 2154-8633 (Print), ISSN: 2154-8641 (Online)
THE INTERNATIONAL JOURNAL OF RELIGION AND SPIRITUALITY IN SOCIETY

among ethnically diverse older adult patients in primary care reported that 80 percent of older
African Americans were depressed compared to 60 percent of White participants in their sample
(Jimenez et al. 2012). Similarly, Williams (2007) reported that African Americans have a
chronicity rate of 56.5 percent for major depressive disorder compared to 38.6 percent for their
White counterparts. Yet fewer than half of African Americans in this study reported seeking
mental health treatment (Williams et al. 2007).
Possible reasons for these lower rates of mental health treatment seeking include: 1) mistrust
of the health system, 2) fear of discrimination and being mislabeled, and 3) fear of being
misdiagnosed (Carpenter-Song et al. 2011; Hall and Sandberg 2012). Many African Americans
cope with mental health issues by meeting with religious leaders for guidance. Chatters and
colleagues (2008) reported that 90.4 percent of African Americans in their study report using
religious coping compared to 66 percent of non-Hispanic Whites in their sample. Conner and
colleagues (2010) similarly reported African Americans tend to first rely on religious coping
(e.g., praying, attending church) to overcome mental health issues.

Role of Religiosity and Spirituality

It is important to note that there is little consensus regarding the definition of religiosity and
spirituality. In our study, we defined religiosity as “an organized system of beliefs, practices,
rituals, and symbols designed to facilitate closeness to the sacred or transcendent God or higher
power” (Hackney and Sanders 2003, 44) and defined spirituality as “the personal quest for
understanding answers to ultimate questions about life, meaning, and relationship to the sacred or
transcendent” (Kasen et al. 2012, 7). Researchers have examined associations between
religiosity, spirituality, and mental health among African Americans (Miller and Thoresen 2003;
Moreira-Almeida et al. 2014; Kasen et al. 2012). When asked to rank the importance of religion
in their lives, African Americans report the highest rankings out of any other racial/ethnic group
in the US (nine out of ten) (Kramer et al. 2007); over 50 percent of African Americans first seek
out African American church leaders when they experience a crisis (Ward et al. 2009).
Additionally, African Americans attribute much more importance to religiosity and spirituality
for understanding and treating mental health issues, compared to other racial/ethnic groups in the
US (Payne 2008; Stansbury 2011).
African Americans tend to first seek out family members, the African American community,
and the Black church for help (Davey et al. 2008; Colbert et al. 2009; Payne 2008; Payne 2009).
Taylor et al. (2000) reported that 79 percent of African Americans who completed the National
Survey of Black Mental Health said religion was the most important part of their lives. In this
study, only 9 percent reported using services from psychologists or mental health providers; they
tended to seek out church leaders when mental health issues occurred (Jackson et al. 2004).
Taken together, prior research suggests African Americans may not actively seek help from
mental health care providers because of mental health stigma and religiosity (Mishra et al. 2009;
Taylor et al. 2010).

Primary Aim of Study

Black church leaders are gatekeepers who facilitate making referrals to outside mental health
services (Neighbors et al. 1998; Oppenheimer et al. 2004; Payne 2009). We need to better
understand their views because they often influence Black congregants’ attitudes about seeking
mental health services when issues occur. Yet few researchers have examined Black church
leaders’ attitudes about seeking outside mental health services and levels of religiosity (Mishra et
al. 2009; Neighbors et al. 1998). In order to fill this gap, we examined 112 church leaders’ views
about seeking outside mental health services in one northeastern urban Baptist African American
mega-church (three nested levels of leadership: twenty-two associate pastors, thirty-four deacons,

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OKUNROUNMU ET AL.: BLACK CHURCH LEADERS’ ATTITUDES ABOUT SEEKING MENTAL HEALTH SERVICES

and fifty-six congregational caregivers). The primary aim of our cross-sectional self-reported
survey study was to describe how church leaders’ levels of religiosity and spirituality are
associated with the following two outcomes of interest: 1) any treatment at all for emotional,
nerve, alcohol, drug or abuse issues and 2) self rated overall physical and mental health. We
hypothesized church leaders who are more religious and who attended church more often would
report using outside mental health services less often.

Methodology
Participants

The sampling frame included all church leaders in three hierarchically nested levels of church
leadership at one urban northeastern Baptist mega-church (twenty-five associate
pastors/ministers, fifty deacons/deaconesses, and 200 deacon aides/congregational caregivers).
Associate pastors are the first level of church leadership who report to a senior pastor; they are
responsible for leading ministries such as pastoral counseling, worship services, fellowship,
evangelism, missions work, discipleship, and administration. Under each associate pastor are
deacons/deaconesses whose duties include: 1) running the Sunday school, 2) helping families
cope with the loss of a loved one, and 3) meeting the needs of church members. The third level of
leadership is deacon aides/congregational caregivers who report to deacons/ deaconesses; their
duties include: 1) communicating with church members, 2) providing information about
membership, 3) praying with congregants and offering guidance, and 4) helping members access
resources inside and outside of the church.

Inclusion/Exclusion Criteria

Specific inclusion criteria were: 1) church leaders who were part of the three levels of leaderships
(associate pastor/minister, deacon/deaconess, and deacon aides/congregation caregivers) at the
urban Baptist mega-church; 2) eighteen years old or older; 3) understand English; and 4)
currently held leadership positions. Exclusion criteria were church leaders who were not active in
their position or who were not able to answer survey questions in English.

Survey Instrument: National Survey of American Life (NSAL)

The National Survey of American Life (NSAL), a 1,535 item valid and reliable self-report
survey, is the most comprehensive study designed to examine the mental health of African
Americans (Jackson et al. 2004). 225 items were chosen from the NSAL, as well as four
questions that asked about how views are transmitted from each of the three hierarchically nested
levels of leadership (see Davey et al. 2010 for review of four transmission questions); a total of
229 questions were included in our survey. The modified self-report survey included the
following sections taken directly from the NSAL: 1) demographic profile; 2) self-rated overall
health; 3) sociocultural factors (level of religiosity and spirituality); and 4) any use of services,
extent of use of services, and satisfaction with services.

Procedure

After first receiving approval from church leaders and the Institutional Review Board at the first
authors’ institution, recruitment flyers were posted at the church and letters were mailed out to all
leaders by church staff; the research team did not have access to the names of church leaders to
preserve their anonymity. The second and third authors were available to distribute surveys to
church leaders during four separate meetings held at the church. All completed surveys were

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coded with numbers, then data was entered into SPSS version 20.0; no names were associated
with the data.

Selected Predictor and Outcome Variables for Analysis

Predictor variables included the following demographic variables: age, gender, income,
importance of being Black versus American, church attendance, and years in leadership role.
Religiosity and spirituality predictor variables include the following Likert-scales and single-
items: importance of religion; overall spirituality; amount of support received from church
members; how often participants are engaged in religious practices outside of church; how often
participants see or talk on the telephone with church members; how often church members help
them; how close participants feel to others at church; how often do participants see, write, or talk
on the telephone with members of church or place of worship; and satisfaction with the quality of
relationships at the church. Outcomes of interest included the following: 1) did you receive any
treatment for emotional, nerve, alcohol, drug, or abuse issues any use of services outside of the
church (1 = yes, 0 = no) and 2) overall self-reported health, which included physical and mental
health.

Data Analysis

Descriptive statistics, correlations, logistic and stepwise regression models were conducted using
SPSS, version 22.0. We ran a logistic regression to examine the effects of the demographic and
religiosity/spirituality variables on our outcome variable (any use of services). We were only able
to examine the question, “Did you receive any treatment for emotional, nerve, alcohol, drug, or
abuse issues?”(anytxemo) because of a lack of variability in outcomes; most church leaders
reported not using formal mental healthcare services. Church leaders more often reported using
alternative health services, including relying on the church community versus more traditional
mental health services when they experienced distress; forty-nine out of 112 church leaders
reported using alternative health services or relying on the church for support (e.g., chiropractor,
acupuncture, aromatherapy, reflexology, yoga, Pilates, tai chi, reiki, church community). We also
ran a stepwise regression model to examine which predictor variables were associated with
church leaders’ overall reports of physical and mental health. A stepwise regression analysis was
chosen so that only those predictor variables that contributed incrementally above and beyond
variables already in the model would be retained.

Results
Church Leader Characteristics

The final convenience sample included 112 church leaders (twenty-two associate
pastors/ministers, thirty-four deacons and deaconesses, and fifty-six deacon aids/congregational
caregivers) out of the sampling frame of 275 leaders (40.7 percent). Twenty-two out of twenty-
five (88 percent) associate pastors/ministers, thirty-four out of fifty (68 percent) deacons and
deaconesses, and fifty-six out of 200 (28 percent) deacon aids/congregational caregivers
completed the self-report survey. Associate pastors/ministers and deacons/deaconesses had more
similarities regarding gender, with ten males and twelve females among associate
pastors/ministers and twenty-one males and thirteen females among deacons/deaconesses. In
contrast, deacon aids/congregation caregivers included primarily females (n = 50 out of 56) in
that role. Associate pastors/ministers and deacons/deaconesses were also similar regarding age;
most reported being between the ages of twenty-eight to fifty-four, while in comparison most
deacon aides/ congregation caregivers were older (ages fifty-five and older). When asked how
they described their race, most associate pastors/ministers (thirteen out of twenty),

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deacons/deaconesses (twenty-seven out of thirty-three), and deacon aids/congregation caregivers

(thirty-seven out of fifty-three) reported they are African American. Additionally across the three
leadership roles, being Black and being American were important aspects of how they racially
identified (60 percent).
Most associate pastors/ministers (fourteen out of twenty-two) and deacons/deaconesses
(twenty-nine out of thirty-four) were married; there was more variation among deacon
aides/congregation caregivers, with eighteen married, fifteen single and never married, fifteen
divorced, six widowed, and one separated. When asked about income levels, most associate
pastors/ministers (fifteen out of twenty), deacons/deaconesses (twenty-five out of thirty-one), and
deacon aides/congregation caregivers (thirty-four out of fifty) reported middle-incomes. Most
church leaders, regardless of their role, had private health insurance for professional mental
health services; seventeen associate pastors/, twenty-six deacons/deaconesses, and fifty deacon
aides/congregation caregivers have private health insurance. Across the three leadership roles,
there were similarities regarding how often participants attended church services; most (104 out
of 112) church leaders reported attending services one to three times a week.

Descriptive Statistics for Predictor and Outcome Variables

The means and standard deviations for the demographic predictor variables are: 1) age (M =
53.39, SD = 11.22); 2) income (M = 3.82, SD = .94); 3) race (M = 3.68, SD = 1.59); 4)
importance of being “Black” or “American” (M = 2.8, SD = .952); 5) church attendance (M =
1.98, SD = .268); and 6) years in leadership role (M = 6.49, SD = 8.19). The means, standard
deviations and scale reliabilities for the religiosity and spirituality predictor variables are (note
that single item predictors do not have reliabilities): 1) importance of religion (M = 23.59, SD =
1.53, α = .12); 2) overall religiosity (M = 1.97, SD = .92); 3) overall spirituality (M = 1.43, SD =
.66), 4) support received from church members (M = 16.44, SD = 2.8, α = .57 ); 5) private
religious activities outside of church (M = 27.59, SD = 3.14, α = .39); 6) how often talk to or see
church members (M = 1.71, SD = .764); 7) how often church members help them (M = 2.67, SD
= 1.36); 8) how close they are to church members (M = 2.12, SD = .95); and 9) satisfaction with
quality of relationships at church (M = 1.55, SD = .76). For the two outcome variables of interest
means, standard deviations, and scale reliabilities are: 1) any treatment at all for emotional,
nerve, alcohol, drug or abuse issues (M = .14, SD = .35, α = .52) and 2) self-rated physical and
mental health (M = 7.66, SD = 1.37, α = .60).

Associations of Demographic, Religiosity/Spirituality and Use of Mental Health Services

Bivariate correlations were run for demographic and religiosity/spirituality predictor variables.
Age was significantly associated with the importance of religion (r = .398, p = .000), suggesting
older church leaders rated religion as more important. Age was also significantly and negatively
correlated with satisfaction with church members’ relationship (r = -.270, p = .005), suggesting
older church leaders tended to report less satisfying relationships with church members. Church
attendance was significantly and negatively correlated with how often leaders engaged in
religious practices outside of church (r = -.201, p = .034), suggesting the more church leaders
reported attending church, the more likely they engaged in religious practices outside of the
church. Church attendance was also significantly associated with how often church leaders talked
to members of the church (r = .195, p = .040), suggesting the more church leaders attended
church, the more they talked to church members outside of the church. Church attendance was
also significantly associated with how often church members helped them out (r = .286, p =
.003), suggesting the more church leaders attended church, the more church members helped
them.
Bivariate correlations were also run for the demographic and religiosity/spirituality predictor
variables and the following two outcome variables of interest: 1) any treatment at all for

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emotional, nerve, alcohol, drug or abuse issues (anytxemo) and 2) self rated overall physical and
mental health. Church attendance was significantly and negatively correlated with church leaders
receiving any treatment at all for emotional, nerve, alcohol, and drug abuse issues (r = -.269, p =
.005); this finding suggests that the more leaders reported attending church, the less likely they
sought out formal mental health services. Age was significantly and negatively correlated with
overall self-rated health (r = -.225, p = .019); older church leaders tended to report worse overall
physical and mental health. Church leaders’ income level was also significantly and positively
correlated with overall physical and mental health (r = .337, p = .001); church leaders with higher
incomes tended to report better overall physical and mental health.

Church Leaders Receiving Any Treatment for Emotional or Substance Abuse Issues

We ran a direct likelihood logistic regression (see Table 1) to examine the impact of a number of
factors on the likelihood church leaders would report receiving any treatment (yes/no) for
emotional, nerve, alcohol, drug, or abuse issues (anytxemo). This logistic model included the
following nine predictors of interest: 1) how important religion is to them; 2) overall religiosity;
3) overall spirituality; 4) support received from church members; 5) how often they engage in
church activities outside of church; 6) how close they are to church members; 7) satisfaction with
quality of church members’ relationship; 8) how often they see, talk to, or write to church
members; and 9) amount of help received from church members; and 10) age, income, church
attendance, and years in leadership role.
The full model with all predictors was statistically significant, (χ2(13, N = 112) = 25.847,
p=.018), indicating the model was able to distinguish between participants who reported any
treatment at all for emotional, nerve, alcohol, drug or abuse issues. The model as a whole
explained between 31.2 percent (R2, Cox and Snell 1989) and 58 percent (R2, Nagelkerke 1991)
of the variance in the report that they had any treatment at all for emotional, nerve, alcohol, drug
or abuse issues and correctly classified 91.3 percent of cases. As shown in Table 1 [See
Appendix], the following demographic predictor of interest made a unique statistically
significant contribution to the model, church attendance (beta = -6.025, p = .010, Wald = 6.675).
One religiosity predictor of interest made a unique statistically significant contribution to the
model, overall religiosity (beta = -2.592, p = .038, Wald = 4.301. This suggests church leaders
who were more religious and who attended church more often, tended to report not going to any
treatment for emotional, nerve, alcohol, drug or abuse issue. After examining the odds ratio for
this variable, for each time a leader reported attending more church, the odds of reporting going
to this type of outside mental health services increased by a factor of 0.2. Noteworthy as
predicted, church leaders who reported being more religious tended to report not receiving any
outside emotional, nerve, alcohol, drug or abuse issues. After examining the odds ratio for this
variable, for each time a leader reported being more religious, the odds of reporting going to this
type of outside mental health services decreased by a factor of 7.5.

Church Leaders’ Physical and Mental Health

After first checking for all regression test assumptions (e.g. normality and outliers), age, income,
church attendance, years in leadership role, importance of religion, overall level of religiosity,
overall level of spirituality, amount of support received from church members, how often engage
in church activities outside of church, how close they are to church members, satisfaction with
quality of relationship with church members, how often see, talk on phone with members of
church), and how often they receive help from church members were included as predictors. No
religiosity/spirituality predictors of interest were significant for overall health and mental health.
Only one demographic variable, income (β = .337, p = .002) stayed in the model, suggesting
church leaders with higher incomes tended to report better overall health. According to the
stepwise analysis the adjusted R2 = F(1,78) = 9.856, p = .002.

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Discussion
African Americans tend to first seek out help from family members, the community, and the
Black church when they experience mental health issues (Davey et al. 2008; Ward et al. 2009).
Prior research suggests African Americans with higher levels of spirituality and religiosity will
be less likely to seek out mental health services outside of the church (Colbert et al. 2009; Payne
2009; Stansbury 2011). We examined the views of 112 church leaders out of a sampling frame of
275 leaders (40.7 percent). Twenty-two out of twenty-five (88 percent) associate
pastors/ministers, thirty-four out of fifty (68 percent) deacons and deaconesses, and fifty-six out
of 200 (28 percent) deacon aids/congregational caregivers were included in this study.
Correlations between the demographic, religiosity/spirituality, and the two outcome
variables (any treatment at all for emotional, nerve, alcohol, drug or abuse issues and self-rated
overall physical and mental health) suggest age was significantly associated with the importance
of religion; older church leaders rated religion as more important to them. Age was also
significantly and negatively associated with overall self-rated health; older church leaders tended
to report worse overall physical and mental health. Church leaders’ income was significantly and
positively associated with overall physical and mental health, suggesting church leaders who had
higher incomes tended to report better overall physical and mental health, which previous studies
have reported (Gary 2005; Thompson-Sanders et al. 2004; Ojeda and Bergstressor 2008).
Noteworthy, the logistic regression analysis suggests church leaders who attended church more
often and who were more religious, tended to report not seeking treatment for emotional, nerve,
alcohol, drug, or abuse issues. Unlike what was predicted, no religiosity or spirituality predictors
were significantly associated with overall health and mental health. Similar to the correlations,
church leaders who reported higher incomes tended to report better overall health which was
expected as individuals with higher incomes tended to have insurance and access to better care
(Ojeda and Bergstressor 2008). Our results support findings from previous studies (Ayalon and
Young 2005; Ward and Heidrick 2009). One explanation for our findings is that church leaders
were able to get their practical and emotional needs met from the church community, so they did
not need outside mental health services. Another possibility is leaders decided to pray and to
attend church more often when mental health issues occurred, however, because of limitations of
the data collected in this study (e.g., Were they experiencing mental health issues?) we cannot
fully explain this finding (Carpenter-Song et al. 2011; Conner et al. 2010).

Limitations

A limitation of our study was the lack of variability in many of the outcomes of interest, because
church leaders tended to report not using formal mental health services and instead relied on
alternative health services and the church community. Additionally, our study was cross-
sectional and relied on self-report using a convenience local sample of church leaders from one
mega-church. Despite these methodological limitations, this is one of the few studies designed to
examine church leaders’ views about seeking outside mental health services using the National
Survey of American Life, a reliable and valid survey developed specifically for African
Americans.

Clinical Implications

Our findings suggest church leaders tend to seek out their church or alternative health services
versus more formal mental health services; therefore, African American church leaders should be
trained to screen and provide mental health services for mild to moderately distressed
congregants. The mental health care system and Black churches should develop more
collaborative partnerships to better meet the needs of this community. Additionally, mental
healthcare providers should be trained to address spirituality and religiosity during clinical

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encounters to help religious African American clients utilize it as a resource but at the same time
not dissuade them from seeking formal mental health services when serious issues occur (e.g.,
major depressive disorder, PTSD).

Future Research

Future research should be conducted with a larger sample of churches that includes church
leaders and congregants to understand how levels of religiosity and spirituality are associated
with seeking outside mental health services. Both self-report and mental health service utilization
data should be collected to increase the external validity of the study. We recommend using more
robust measures of religiosity and spirituality as most items in the NSAL were single items.

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OKUNROUNMU ET AL.: BLACK CHURCH LEADERS’ ATTITUDES ABOUT SEEKING MENTAL HEALTH SERVICES

APPENDIX
Table 1: Summary of Results from Logistic Regression Model Predicting Any Treatment
at all for Emotional, Nerve, Drug, Alcohol, or Abuse Issues (anytxemo)
Predictors Exp (B) 95% CI
Sociodemographic
Age 1.068 .899–1.268
Income 1.832 .567–.5.921
Church attendance .002* .000–.234
Years in Leadership role .964 .813–1.143

Religiosity/Spirituality
Import (How important religion is to them) .745 .279–1.990
OverallR (Overall level of religiosity) .075* .006–.867
OverallS (Overall level of spirituality) 1.101 .138–8.810
Support (Amount of support received from church members) .748 .398–1.406

Private (How often they engage in church activities outside of church) 1.240 .740–2.078

Close (How close they are to church members) 9.879 .582–167.612

Relation (Satisfaction with quality of relationships at church) .306 .025–3.776

Talk (How often see, talk on phone with members of church) .727 .082–6.486

Help (How often they receive help from church members) 1.709 .378–7.730
Note. *p < .05 **p < .001

ABOUT THE AUTHOR

Elizabeth Okunrounmu: Doctoral Student, Couple and Family Therapy Doctoral Program,
Drexel University, Philadelphia, Pennsylvania, USA

Argie Allen-Wilson: Director of Clinical Training, College of Nursing and Health Profession,
Drexel University, Philadelphia, Pennsylvania, USA; Director of Clinical Training, Couple &
Family Therapy Department, Drexel University, Philadelphia, Pennsylvania, USA

Maureen Davey: Associate Professor, College of Nursing and Health Professions, Drexel
University, Philadelphia, Pennsylvania, USA; Associate Professor, Department of Couple and
Family Therapy, Drexel University, Philadelphia, Pennsylvania, USA

Adam Davey: Professor, Department of Epidemiology and Biostatistics, Temple University,

Philadelphia, Pennsylvania, USA; Chair, College of Public Health, Temple University,
Philadelphia, Pennsylvania, USA

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