VanderWeele, T.J. (2017). Religious communities and human flourishing. Current Directions in Psychological
Science, in press. https://doi.org/10.1177/0963721417721526
Religious Communities and Human Flourishing
Tyler J. VanderWeele
Harvard T.H. Chan School of Public Health
677 Huntington Avenue, Boston MA 02115
Abstract
Participation in religious services is associated with numerous aspects of human flourishing
including happiness and life satisfaction, mental and physical health, meaning and purpose,
character and virtue, and close social relationships. Evidence for these effects of religious
communities on flourishing now comes from rigorous longitudinal study designs with
extensive confounding control. The associations with flourishing are much stronger for
communal religious participation than for spiritual-religious identity or for private practices.
While the social support is an important mechanism relating religion to health, this only
explains a small portion of the associations. Numerous other mechanisms appear to be
operative as well. It may be the confluence of the religious values and practices, reinforced by
social ties and norms, that give religious communities their powerful effects on so many
aspects of human flourishing.
Introduction
Studies over the past several decades have provided increasingly strong evidence for an effect
of participation in religious communities on numerous aspects of human well-being (Koenig
et al, 2012; Idler, 2014; VanderWeele, 2017). While many of the early studies were
methodologically weak, there is now a large body of rigorous empirical studies with
longitudinal data and good confounding control (VanderWeele et al., 2016a) that indicate that
religious community is a major contributor to human flourishing.
Religion and Physical and Mental Health
Longitudinal studies indicate that attending religious services at least weekly is associated
with 25-35% reduced mortality over ten to fifteen years. The effects may be larger for women
than men, and for black individuals than white, but they seem to persist across gender, race,
and across different religious groups as well (Strawbridge et al., 1997; Hummer et al., 1999;
Musick et al., 2004; Chida et al., 2009; Koenig et al., 2012; Idler, 2014; Li et al., 2016a;
VanderWeele, 2017). One study indicated that if regular service attendance were maintained
over the life course the lower mortality rates would translate into approximately seven
additional years of life (Hummer et al., 1999).
Religious service attendance is also associated with numerous health behaviors over time
including less frequent smoking initiation, greater smoking cessation, less alcohol abuse, and
less illegal drug use; attendance is not, however, strongly protectively associated with all
health behaviors as the associations with diet, exercise, and weight appear more mixed
(Strawbridge et al., 1997; Koenig et al., 2012; Idler, 2014).
Religious service attendance is also longitudinally associated with better mental health
including approximately 20%-30% lower rates in the incidence of depression (Li et al.,
2016b; Koenig et al., 2009; VanderWeele, 2017), and with 3-to-6-fold lower rates of suicide
(Kleinman and Liu, 2014; VanderWeele et al, 2016b). While cross-sectional studies suggest a
protective association with anxiety, this does not seem to hold up in longitudinal analyses
(Koenig et al., 2012; Li et al., 2016a).
Religion and Social Relationships
There is also evidence that religious service attendance is associated with better social
relationships. Numerous studies have examined associations between attendance and divorce
(Koenig et al., 2012). While many of these are cross-sectional, the longitudinal designs
suggest that those attending religious services at baseline are 30%-50% less likely to divorce
in follow-up (Strawbridge et al., 1997; Wilcox and Wolfinger, 2016; Li et al., 2016c). There
are also longitudinal studies that indicate religious service attendance is associated with an
increased likelihood of subsequently making new friends, of marrying, of having nonreligious
community membership, and of higher social support (Strawbridge et al., 1997; Lim
and Putnam, 2010; Wilcox and Wolfinger, 2016; Li et al., 2016c).
Religion and Life Satisfaction
Numerous studies have also indicated an association between attending services and
happiness and life satisfaction (Myers, 2008; Koenig et al., 2012); almost all of these are
cross-sectional, but the existing longitudinal evidence, controlling for numerous social and
demographic covariates and baseline life satisfaction, offers confirmation of this (Lim and
Putnam, 2010).
Religion and Meaning
Other studies have examined meaning and purpose. The vast majority of these have suggested
that service attendance is associated with a greater sense of meaning or purpose in life, but,
once again, almost of these studies are cross-sectional (Koenig et al, 2012). However, there is
also some evidence that service attendance is longitudinally associated with greater meaning
in life, even after control for social and demographic covariates and baseline meaning in life
(Krause and Hayward, 2012).
Religion and Virtue
With the relationship between religion and virtue, once again, many of the studies employ
cross-sectional designs. However, there is longitudinal evidence that those who attend
services are subsequently more generous in charitable giving, more likely to volunteer, and
are more civically engaged (Putnam and Campbell, 2012). There is also evidence that
religious service attendance is associated with lower rates of crime, and while most of this
evidence again comes from cross-sectional studies, the evidence from longitudinal studies
appears to confirm this as well (Johnson et al., 2001; Johnson, 2011). In the case of character
and virtue, there is also some interesting evidence from experimental designs, not specifically
concerning religious service attendance, but other aspects of religions. There have been a
number of randomized priming experiments suggesting at least short term effects of religious
prompts on pro-social behavior (Shariff, 2016). There is also some experimental evidence that
encouragement for couples to pray together increases forgiveness, gratitude and, trust
(Lambert et al., 2012).
Evidence for Causality
There is thus evidence that religious service attendance is longitudinally associated with
happiness and life satisfaction, physical and mental health, meaning and purpose, character
and virtue, and close social relationships. A question that naturally arises is whether these
associations are causal.
Many of the early studies on religion and health were methodologically weak and used crosssectional
data. This is problematic because of the possibility of reverse causation – that only
those who are healthy can attend services. The only way to attempt to rule this out is to use
longitudinal data collected over time and to control for baseline health (VanderWeele et al.,
VanderWeele, T.J. (2017).
As noted above, there are now numerous longitudinal studies examining service
attendance and mortality, depression, suicide, divorce, etc., with good confounding control,
and in these studies the associations still persist. Nevertheless, these studies do make use of
observational data, and it is always possible that unmeasured confounding may explain some
of these associations. It is, however, possible to use sensitivity analysis (VanderWeele and
Ding, 2017) to examine how strong such unmeasured confounding would have to be to
explain away the associations. For example, Li et al. (2016a) reported that to explain away the
estimate of 33% lower mortality in follow-up for those regularly attending services, an
unmeasured confounder that was associated with both lower mortality and greater attendance
by risk ratios of 2.35-fold each, above and beyond the measured confounders, could explain
the association away, but weaker confounding could not. Such substantial confounding by
unmeasured factors may be unlikely, given adjustment already made for an extensive set of
measured confounders.
The corresponding measures to explain away the 29% lower depression incidence for those
regularly attending services would be an unmeasured confounder associated with service
attendance and lower depression by risk ratios of 2.1-fold each. And the corresponding
measures to explain away the 84% lower suicide risk for those regularly attending services
(VanderWeele et al., 2016b) would be an unmeasured confounder associated with service
attendance and lower suicide by risk ratios of 12-fold each. In this case, extremely strong
unmeasured confounding would be required. With observational data, one can never be
certain about causality, but the results of sensitivity analysis, after extensive control for
measured covariates, suggest that the evidence that some of the association is causal is quite
strong. Another form of evidence that some of the association between religion and health and
well-being is causal is that there are a number of plausible mechanisms.
Mechanisms
Numerous mechanisms, or potential mediators, have been proposed for the associations
between religious service attendance and health. Assessing mechanisms is more difficult and
the research on this for service attendance is not as strong (VanderWeele, 2015).
Nevertheless, for the relationship between attendance and mortality there is evidence that
social support, lower smoking, greater optimism, and lower depression may all be important
(Koenig et al., 2012; Li et al., 2016a). Greater meaning and purpose in life and greater selfcontrol
have also been proposed as possible mechanisms (Koenig et al., 2012).
The existing evidence also suggests that the mechanisms may vary across outcomes. For the
effect of religious services on decreased depression, the mechanisms of social support,
optimism, and meaning in life might all be important (Koenig et al., 2012). For greater life
satisfaction, the social relationships that religious services provide seem to play an especially
important role, perhaps accounting for nearly half of the effect (Lim and Putnam, 2010). For
the dramatically lower suicide rates among those attending religious services, while social
support, less alcohol, and less depression may account for some of the effect, these factors
may not be as explanatory as might be thought and the moral belief that suicide is wrong,
reinforced by religious communities, is perhaps here of considerable importance (Koenig,
VanderWeele, T.J. (2017). With lower divorce rates among those attending religious
services, the programs within religious communities that support families and marriages are
likely important, as are perhaps the teachings on love and sacrifice, the prohibitions against
infidelity and divorce, and greater levels of life satisfaction and lower depression within
married life (Wilcox and Wolfinger, 2016; Li et al., 2017).
Another important mechanism relating religious participation to health may be the use of
religious coping. Most Americans use religion or spirituality to cope with illness or stress
(Koenig et al., 2012), and there is evidence that this likewise leads to better mental and
physical health outcomes, at least in clinical contexts (Pargament et al., 2004). Religious
coping may help in finding meaning and strengthening relationships in the context of
suffering and illness. Another mechanism by which religious participation may affect health is
that of forgiveness, the replacing of ill-will towards an offender with good-will (Worthington,
2013). Many religious groups promote some notion of forgiveness. The existing research
suggests that forgiveness is itself associated with better mental health, and possibly with
better physical health (Toussaint et al., 2015). Relatively strong evidence comes from
randomized trials of interventions to promote forgiveness: meta-analyses indicate that these
forgiveness interventions have beneficial effects not only on forgiveness, but also on
depression, anxiety, and hope (Wade et al., 2014). Although most of these forgiveness
interventions do require a trained professional, there is some preliminary randomized trial
evidence that even workbook forgiveness interventions, that can be done on one’s own, are
effective in bringing about forgiveness and perhaps alleviating depression (Harper et at.,
2014; cf. http://www.evworthington-forgiveness.com/diy-workbooks). Religious groups
promote forgiveness and forgiveness itself can restore relationships, and improve mental
health and well-being. There thus appear to be many pathways from religious service
attendance to health and well-being.
Religious Community
An interesting aspect of the religious participation research is that it suggests that it is
religious service attendance, rather self-assessed spirituality or religiosity, or private practices,
that most powerfully predicts health and well-being. Private practices, spiritual or religious
identity, and religious coping are all more weakly associated with health (Musick et al., 2004;
VanderWeele et al., 2017). Religious identity and private spiritual practices may of course
still be important and meaningful within the context of religious life, but they do not appear to
affect health and well-being as strongly. The communal element seems essential.
This also raises the question as to whether it is just community that matters, and whether any
community would be as effective. While social support is an important mechanism relating
religious service attendance to better health and lower mortality it seems to only explain about
a quarter of the effect (Li et al., 2016a). Moreover some data indicate that, religious service
attendance is a stronger predictor of health and longevity than any other social support
variable, including being married, number of close friends, number of close relatives, having
recently seen a friend, or a relative, and hours spent in social groups (Li et al., 2016a).
Certainly other measures of social support and community participation do seem to be
associated with better health as well but the existing evidence suggests that the effects are not
as strong, nor over such a broader range of outcomes; moreover weekly participation in
religious services – still at 36% in the United States – seems to be a far more common form of
community involvement than any other (VanderWeele, 2017).
Nevertheless, given the diversity of the mechanisms, we might wonder how many of them
really are fundamentally religious in nature. While many of the mechanisms relating religion
to health – social support, smoking, meaning and purpose, optimism – are seemingly not
distinctively religious, and could be operative in other contexts as well, some of these are
arguably quite central to religious practice. Greater optimism and less depression may result
from religious messages of faith and hope; meaning and purpose follow directly from
profound religious understandings of the world and the place of human persons in it; even
with something as seemingly mundane as less smoking, religious teachings that the body is a
gift from God wherein the spirit dwells may have some effect on altering such behaviors.
Thus, religious ideas may in fact be intertwined with many of these mechanisms. It is perhaps
the bringing together of the religious and the social that gives religious service attendance its
powerful effects.
Negative Effects of Religious Community
Of course religious service attendance and participation can potentially have detrimental
effects as well. There is some evidence that the effect of attendance is less pronounced and
even detrimental in countries which restrict freedoms (Hayward and Elliott, 2014); students in
schools where their own religious affiliation is in the minority may be more likely to attempt
suicide or self-harm (Young et al. 2011); in one study, religious participation was associated
with higher depression rates for unwed mothers (Koenig, 2009). Spiritual struggles have also
been shown to be associated longitudinally with worse health (Pargament et al., 2004), and
negative congregational interactions are associated with lower measures of well-being
(Ellison et al., 2009). While much of the evidence thus points to a beneficial effect of
religious participation on health, it is clear that there are contexts and settings for which this is
not so. Such research can also be of importance to religious communities in informing
communal and pastoral practices.
Human Flourishing, Society, and the Ends of Religion
The review here has focused on religious community and individual flourishing. However,
there is of course a broader societal dimension, which should be considered when assessing
religion’s contribution to human well-being both generally and also towards those who do not
or no longer participate in religious communities. We have not, for example, discussed
religious acts of terrorism, or child sexual abuse in religious contexts. While abuse rates may
be even higher in the general population (Koenig, 2017), the fact that they took place at all in
religious contexts is very troubling. In evaluating the contribution of religious communities to
flourishing, one would also want to take into account these problematic aspects as well, but
similarly likewise the many contributions of religious communities to broader society as well
such as food pantries, soup kitchens, prison outreach, counseling, civil rights, and Alcoholics
Anonymous services (Idler, 2014; Levin, 2016), as well as the extensive provision of medical
care. In some African countries faith-based organizations may provide as much as half of all
care (Idler, 2014). These are all undoubtedly crucial in evaluating the role of religion in
society.
An even broader perspective might consider the historical contributions of religious
communities, both positive and negative, such as the role such communities did or did not
have in so-called wars of religion, and also in the development of hospitals, economics, law,
human rights, science, and the preservation of learning (Carroll and Shiflett, 2001;
Cavanaugh, 2009; Woods and Canizares, 2012).
But a yet broader perspective still would also consider what religious communities view as
their own ends and purposes. Of course, neither health, nor worldly satisfaction, is the
primary focus of the world’s major religious traditions. Instead, a vision of or communion
with God, or the living life as God intended, or a restoration to complete wholeness, are often
central in the primary ends of religious communities (Aquinas, 1948; Catholic Church, 2000;
Westminister, 2014; Koenig et al., 2012). Many religious communities teach that ultimate
well-being extends beyond flourishing in this life and that these final ends of religion are to be
given greater value. Given the focus of religion on the transcendent, it is thus perhaps
remarkable that participation in religious communities affects so many human flourishing
outcomes in life, here and now, as well.
Acknowledgements
This work was funded by the Templeton Foundation and by the Program on Integrative
Knowledge and Human Flourishing at Harvard University.
VanderWeele, T.J. (2017). Religious communities and human flourishing. Current Directions in Psychological
Science, in press. https://doi.org/10.1177/0963721417721526
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Recommended Readings
Idler EL, Ed. (2014). Religion as a Social Determinant of Public Health. New York: Oxford
University Press.
Koenig HG, King DE, Carson VB. (2012). Handbook of Religion and Health. 2nd ed. Oxford,
New York: Oxford University Press.
Lim C, Putnam RD. (2010). Religion, social networks, and life satisfaction. American
Sociological Review, 75:914–933.
Strawbridge WJ, Cohen RD, Shema SJ, Kaplan GA. (1997). Frequent attendance at religious
services and mortality over 28 years. American Journal of Public Health, 87(6):957–961.
VanderWeele, T.J. (2017). Religion and health: a synthesis. In: Peteet, J.R. and Balboni, M.J.
(eds.). Spirituality and Religion within the Culture of Medicine: From Evidence to Practice.
New York, NY: Oxford University Press.
