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. Author manuscript; available in PMC: 2020 Aug 1.
Published in final edited form as: Psycholog Relig Spiritual. 2018 Jun 7;11(3):203–213. doi: 10.1037/rel0000184

Spirituality and its Relation to Mental Health Outcomes: An Examination of Youth in Foster Care

Kalani Makanui 1, Yo Jackson 2, Stephanie Gusler 3
PMCID: PMC6871520  NIHMSID: NIHMS968782  PMID: 31754408

Abstract

The effects of spirituality and youth relationships with others on internalizing, externalizing, and adaptive outcomes were examined in a sample of 159 youth between the ages of 8 and 21 in foster or residential care. Indirect effects of direct coping and perceived social support on the relations between these factors and youth outcomes were examined. Preliminary analyses indicated a significant relation between youth spirituality and adaptive outcomes, with a significant indirect effect of perceived social support on these relations. However, these relations were nonsignificant when accounting for youth relationships with others. Final results indicated that youth relationships with others significantly affected youth adaptive functioning through both coping and perceived social support. Youth relationships also significantly affected youth internalizing symptoms, albeit only through youths’ perceived levels of social support. These findings suggest that, while spiritual beliefs are potentially an important factor in affecting outcomes for foster youth, the strongest effects likely occur through youths’ relationships with others, social support, and coping in relation to adaptive outcomes for these youth.

Keywords: spirituality, foster youth, coping, social support

According to the most recent Adoption and Foster Care Reporting System (AFCARS) data, over 415,000 children in the United States were in foster care near the end of the 2014 fiscal year (AFCARS, 2015). During the same year, approximately 265,000 children entered the foster care system for the first time. Although placement in foster care is almost always a response to allegations of child abuse and a legal step by a state to ensure the safety and well-being of children, the experience of being a foster child, coupled with a history of maltreatment, is related to a host of negative psychological outcomes (Oswald, Heil, & Goldbeck, 2010). However, not all youth in foster care fare poorly. Fernandez (2009) reported a number of positive outcomes in a study of foster children followed longitudinally over a period of eight years, providing evidence that youth in foster care can potentially display positive behavioral and interpersonal functioning despite their experiences in care. Systematic investigation of factors accounting for the multifinality of outcomes for youth in foster care is sorely needed. The current study addressed this need by examining one of these proposed factors, spirituality, and its relation to adjustment in foster youth. Because the prevalence estimates of various negative mental health disorders in foster youth are significantly higher compared to youth not in foster care, and because of systemic disruptions and an increased risk for legal and emotional problems as adults, the scientific study of children in care has become a recent priority for researchers, policymakers, and care providers alike (Lee, Courtney, Harachi, & Tajima, 2015; Tarren-Sweeney, 2008; Pilowsky & Wu, 2006).

Evidence for Resilience in Foster Youth

Perhaps as important as the study of negative outcomes is inquiry into how children “overcome the odds” and display positive adjustment despite their maltreatment and foster care experiences. For example, a study conducted by Daining and DePanfilis (2007), which examined 189 foster youth over 18 years of age who had left care, provided further evidence for positive adjustment in foster youth in spite of their stressful life experiences. As a whole, the sample reported moderately high ratings of positive adjustment assessed across numerous domains, including educational participation, employment, and avoidance of drug use and criminal activity. Prior research has found support for the notion that various dimensions (both individual and relational) contributed to favorable outcomes in youth. For example, a greater number of close friendships and relationships with adult mentors (a relational factor) predicted lower levels of anxiety, lower levels of physical aggression (Legault, Anawati, & Flynn, 2006), and greater reported resilience (e.g., perseverance, self-confidence, and meaning in life) in foster youth (Mota & Matos, 2015).

Although understanding the role of relational factors is important for children in foster care, relationships with others are often in flux. Therefore, the investigation of individual factors like spirituality, which can affect beliefs and understanding of how the world works, may present particularly fertile ground for learning how foster youth will respond to new routines, home environments, families, and schools (Ivtzan, Chan, Gardner, & Prashar, 2013; Roehlkepartain, King, Wagener, & Benson, 2006). Furthermore, factors like spirituality can be particularly helpful for foster youth in managing transitions, given that beliefs and faith can potentially provide foster youth with a sense of stability and consistency across the changes and transitions they may experience. Crawford, Wright, and Masten (2006) suggested that, for youth who fail to form secure attachments due to abuse, parental loss, or living within dangerous or chaotic environments, “a relationship with a higher power seems to offer security in the form of a substitute attachment figure” (pp. 358). Thus, spirituality has become a promising area of research for examining potential influence on outcomes in foster youth, and has been suggested as a potential mechanism by which positive adjustment occurs (Jackson et al., 2010). Furthermore, there is a great need within the field to move from the examination of spirituality as a broad construct toward more specific studies explicating which factors and mechanisms of spirituality impact which specific dimensions of well-being (Pargament, 1999), particularly with potentially at-risk populations like youth in foster care.

Relation of Spirituality to Mental Health Outcomes in Youth

Cotton et al. (2006) conducted a review of the literature examining spirituality and the mental and behavioral health sequelae of adolescents. Their review found support for the important role of spirituality in influencing health outcomes in adolescents; those who endorsed more strongly held spiritual views engaged in less risky sexual activity, fewer instances of violent behavior, had a lower risk for substance use, evidenced fewer symptoms of depression, and even demonstrated a decreased risk of suicide compared to adolescents who endorsed low levels of spirituality. Prior research provides preliminary evidence for the existence of a number of factors that might impact the relation between spirituality and youth outcomes.

Exploring Mechanisms by Which Spirituality Affects Outcomes

Coping as a mechanism

Researchers have suggested that spirituality may provide protective benefits to youth in care for a variety of reasons. Spirituality may be related to the coping strategies that children utilize to manage the events that have occurred in their lives; through spirituality, they may be able to explain, understand, and provide a framework of meaning to the maltreatment events they have experienced (Lazarus & Folkman, 1984; Weber & Pargament, 2014). Preliminary evidence for this notion has been provided by Kim (2008). In a study of over 190 maltreated youth between the ages of 8 and 12, strong endorsement of spiritual beliefs and practices was associated with low levels of internalizing behaviors for girls and low levels of externalizing behaviors for boys. Support was found for the importance of the internal indicator of spirituality (e.g., importance of faith) in predicting outcomes in youth, and the authors concluded, “factors associated with greater religiosity, especially the private aspect of spirituality measured by importance of faith, seem to have the potential to reduce the effects of high stress levels associated with maltreatment experiences…” (p. 717). According to Crawford et al. (2006), internal aspects of spirituality likely provide a framework within which stressors can be understood, resulting in higher confidence in one’s ability to use active or direct methods of coping with seemingly overwhelming stressors.

The relation between coping and outcomes in youth has received greater attention in the literature than the effects of spirituality on outcomes. For example, Thompson, Lengua, and Garcia (2016) found that direct/active coping strategies (e.g., dealing with problems, and trying to solve them) were more predictive of a number of positive psychological outcomes in children than inactive/avoidant coping strategies (e.g., doing something else instead). Additionally, research on spiritual coping has found positive religious coping (e.g., believing in God’s benevolent plan for struggles) to be associated with direct behavioral coping strategies such as problem solving and assistance seeking (Terreri & Glenwick, 2013). However, as Exline, Yali, and Lobel (1999) discovered, spirituality can also be associated with negative emotions, particularly when one feels angry at or alienated from God. Extending Exline and colleagues’ research (1999), a study found negative religious coping (e.g., believing that one is being punished by God and feeling conflict or anger at God) to be associated with cognitive and behavioral avoidance (Terreri & Glenwick, 2013). Other lines of research have demonstrated that direct coping strategies mediate the impact of experiencing traumatic events on negative mental health sequelae in children (Chen, Wang, Zhang, & Shi, 2012). These studies suggest that coping, specifically direct coping, is an important factor for predicting psychological outcomes in youth. Coupled with Kim’s (2008) suggestion that coping might be the active mechanism by which internal aspects of spirituality affect change in outcomes, these two lines of research suggest a mediated or indirect relation between internal aspects of spirituality and outcomes in children through coping. The current study attempted to expand on these preliminary findings and added to the field by utilizing multiple indicators to assess spirituality, and by providing the first empirical test of coping as an indirect mechanism by which spirituality affects outcomes in foster youth.

Social support as a mechanism

In addition to influencing youth adjustment through its impact on internal processes (e.g., coping), spirituality may also affect external factors important to youths’ overall well-being. For example, spirituality may affect adjustment by providing a means to access alternate sources of social support (e.g., new friends, church involvement, and opportunities to participate in church activities), which can assist youth through emotional difficulties. According to Smith (2003a), engagement in religious congregations and activities, “can provide relatively dense networks of relational ties within which youth are embedded, involving people who pay attention to the lives of youth, and who can provide oversight of and information about youth to their parents and other people well positioned to discourage negative and encourage positive life practices among youth” (p. 260). Given that many religions stress the importance of service and support to others, and also provide opportunities for their members to build social relationships, involvement in spiritual and religious opportunities likely also give children an additional source for social support (Crosby, Robert, & Smith, 2015). Prior research has suggested that social support can be an important mediator of the relation between exposure to violence and negative youth outcomes. Daining and DePanfilis (2007) found that, among a sample of foster youth transitioning to adult care, social support contributed significantly and uniquely to youth well-being, above and beyond the effects of perceived stress, gender, and age of time in care, suggesting positive effects of social support for youth even during the transition out of care and into adult life. Taken together, these lines of research provide evidence for a possible mediated or indirect relation between spirituality and outcomes through social support, a relation that was tested for foster youth in the current study.

Current Study

For the current study, it was hypothesized that for youth in foster care (1) direct coping would evidence significant indirect effects on the relation between proximal indicators (e.g., beliefs and attitudes toward a Higher Power) of spiritual functioning and youth-reported adaptive outcomes, while social support would evidence significant indirect effects on the relation between distal aspects of spiritual functioning (e.g., church attendance, participation in religious/spiritual activities) and youth-reported adaptive outcomes. The analyses were repeated for internalizing outcomes and externalizing outcomes.

Methods

Participants

Study approval and participant recruitment

The data for the current study were collected as part of a larger, federally funded study examining pathways to positive adjustment for youth in foster care. The larger study (SPARK [Studying Pathways to Adjustment and Resilience in Kids]) as well as the subset of measures utilized in this study were approved by University Institutional Review Board (IRB). Given that children in foster care are often under guardianship of the state in which they reside, special permissions were first obtained from court judges with jurisdiction over consent for the potential study participants. Once necessary legal permission was obtained, the research team attended various county and local meetings to facilitate project recruitment. Interested families were given further information about participating in the study. Once families (both foster parents and children) expressed interest, they were informed further about the study. Informed consent was provided/obtained, wherein study participants were notified that their responses would remain confidential (de-identified within the computer data collection system, to which only specific team members would link assigned participant IDs with actual responses). Written/verbal consent was obtained from foster parents, while verbal/written assent was obtained from youth participants. All participants were informed of the voluntary nature of the study.

Participants were 159 youth in foster (n = 76) or residential (n = 83) care in the state of Missouri (between the ages of 8 and 21 years, [M = 13.59, SD = 3.01 years]). In terms of differences between foster and residential care in the U.S., children in foster care are typically placed with foster parents/families within caregivers’ homes, while children in residential settings tend to be older and potentially exhibit more severe emotional and behavioral concerns requiring a higher level of ongoing monitoring. Our sample was selected based on volunteerism, with the potential for sample selection bias noted in the Limitations section. The original sample size for the current study consisted of reports from 174 youth; however, 15 youth were excluded from final analyses due to scores indicating possible intellectual disability on a screening measure of cognitive functioning utilized as part of the larger study (the Kaufman Brief Intelligence Test [K-BIT; Kaufman, 2006]).

The sample was composed of a higher percentage of African American foster youth than is represented in Missouri State care (50% vs. 28%), and a smaller percentage of Caucasian children when compared to statewide estimates (30% obtained compared to 66% statewide). The obtained sample contained a percentage of Latino and/or Hispanic children comparable to statewide representation (3% obtained vs. 3% statewide). Approximately 15% of the obtained sample was identified by caregivers as multiracial, belonging to two or more ethnic groups. The obtained sample closely mirrored statewide averages in terms of gender representation (46% female and 54% male for the obtained sample vs. 48% female and 52% male statewide).

Measures

Spirituality and relationships with others

The Youth Spirituality Scale (YSS; Sifers, Warren, & Jackson, 2012) and the Moral Religious Emphasis (MRE) of the Family Environment Scale (FES; Moos & Moos, 1986) were used to measure processes of youth spirituality. For the present study, strong internal consistency was obtained for the YSS Total Scale Score (α = .89), indicating high scale reliability. The current study utilized only the Moral Religious Emphasis (MRE) subscale of the FES. Internal consistency obtained for the current sample was .66, indicating moderate scale reliability for this scale. For the YSS, items were anchored on a 5-point Likert response scale, ranging from 1 (Never True for Me) to 5 (Always True for Me). For the MRE, responses were anchored on a dichotomous (e.g. True-False) response scale.

Confirmatory and Exploratory factor analysis were performed on the YSS and MRE, indicating two distinct factors. The first factor, entitled Spirituality, formed a superordinate category of spiritual beliefs and practices (compared to original hypotheses, where proximal and distal qualities were thought to be separate); the items contained within the Spirituality factor were related to any beliefs, ideas, and practices involving God or a Higher Power. This factor, which consisted of 11 items, evidenced strong internal consistency (α = .88). The second obtained factor (consisting of 6 items) indicated themes related to relationships with others (e.g., trusting in others, and being nice) as well as performance of behaviors that sanction social cohesion (e.g., apologizing to others, and forgiving others often). This second factor was entitled Relationship with Others (RO). Factor 2 evidenced moderate internal consistency (α = .74). Specific item content of these two factors is available upon request.

Behavioral Inventory for Strategic Control (Direct Coping Strategies)

The Behavioral Inventory for Strategic Control (BISC; Little, Lopez, & Warner, 2000) was utilized to assess youths’ coping methods across a number of domains (e.g., general, academic, and social). The BISC is a 180-item youth-report measure yielding seven subscales indicative of various coping methods employed by children in commonly encountered situations. For the current study, reports on the Direct Action subscale were included in analyses, to assess proactive coping strategies (e.g., trying to cope with problems as they arise, and trying to solve problems). The BISC allows researchers to design “frames” (sentence stems) to apply to stressors that the child may currently be experiencing. For example, one of the BISC frames was adapted to ask foster youth in the study about how they cope with difficulties changing schools and homes. Thus, the BISC is a coping measure easily adapted to foster youth, and it likely captures their coping styles in relation to situations they commonly encounter. For the current study, a subset of 45 items relevant to foster youth was selected; items were anchored on a 5-point Likert scale ranging from 1 (Never True for Me) to 5 (Always True for Me). Internal consistency for the BISC Direct Action Scale was strong (α = .96), indicating high reliability.

Social Support Scale for Children (Social Support)

The Social Support Scale for Children (SSSC; Harter, 1985) was utilized to assess youths’ levels of perceived social support from a number of sources, including parents, friends, teachers, and classmates. For the present study, the Total Support score (consisting of 24 items total, utilizing a forced response scale anchored with 4 response points) was utilized as an overall indicator of social support perceived by the child or adolescent. Alpha coefficients for the various SSSC scales ranged from moderate to high, between α = .76 (Classmate Support subscale) and α = .81 (Parent and Friend Support Subscales). The coefficient alpha for the Total Support score was .68, indicating moderate scale reliability.

Internalizing and Externalizing Problems

The Behavior Assessment System for Children – Second Edition (BASC – II; Reynolds & Kamphaus, 2004) was administered to youth to assess both internalizing and behavioral problems, as well as personal adjustment. One of two versions of the BASC – II was given to youth respondents according to age (BASC – II – Child Report = ages 8 to 11; BASC – II – Adolescent Report = ages 12 to 21). The BASC – II Self Report: Child (SRP - C) version is a 139-item questionnaire yielding 14 subscales and 5 composite scores. Respondents are asked to rate a number of behaviors on a 5 – point Likert scale (“Never” to “Almost Always”); composite indices include Emotional Symptoms, Inattention/Hyperactivity, Internalizing Problems, Personal Adjustment, and School Problems scores. The BASC – II Self Report: Adolescent (SRA) version contains 176 items, and yields indices and subscales similar to the child version (with an additional Sensation Seeking and Somatization scale). For the current study, the Internalizing, Inattention/Hyperactivity, and Personal Adjustment Composite scales were included in analyses as indicators of self-reported emotional and adaptive functioning in youth. For the current study, alpha coefficients between .61 (Personal Adjustment Composite) and .87 (Externalizing Composite) were obtained, suggesting moderate to high internal Composite Score reliability.

Procedures

Audio-Computer Assisted Survey Interviewing (A-CASI)

Surveys were administered via Audio Computer Assisted Survey Interview. Audio-Computer Assisted Survey Interview (A-CASI) is a computer platform that allows for computer administration of study questions to participants. A-CASI includes both visual (on-screen text) and audio (pre-recorded sound files which read questions to participants via headphones) methods of administration. Participants were acclimated to the survey instrument via the inclusion of a tutorial demonstrating how various functions of the computer and the administration interface operated. The order of study measures was randomized, to control for potential fatigue effects (given the large number of items that participants were asked to rate). Evidence for the effectiveness and utility of A-CASI interviewing with youth has been provided by Romer et al. (1997), who reported that survey data obtained from computer interviewing demonstrate reliability comparable to face-to face interviews conducted with children.

Results

Descriptive Statistics

Descriptive statistics (including means and standard deviations) for study measures are presented in Table 1. Reports on the data-derived Spirituality factor and on the Relationship with Others (RO) scale were normally distributed (skewness and kurtosis estimates were within ± 1). Responses on the BISC and the SSSC were also normally distributed, presenting distributions and mean scores similar to those obtained during measure standardization. (Little et al., 2001; Harter; 1985). Youths’ mean scores on the BASC Internalizing Composite indicated average (e.g., non-clinical) symptom frequency and severity compared to age-matched youth. Youths’ mean scores on the BASC Inattention/Hyperactivity Composite scale also indicated symptom frequency and severity comparable to age-matched children.

Table 1.

T-Tests (with Bootstrapping) Comparing Mean Scale Scores for Foster vs. Residential Participants (Mean Difference Derived from Foster – Residential Mean Scores)

t score df Mfoster (SDfoster) Mresidential (SDresidentail) Mean Difference CI (95%), Lower Bound CI (95%), Upper Bound
SSSC 2.35 157 3.43 (.45) 3.24 (.56) .19 0.29 .35
BASC INT CR −3.12 157 53.17 (8.28) 57.24 (8.17) −4.07 −6.65 −1.58
BASC PA CR 2.19 157 51.62 (5.36) 49.57 (6.34) 2.05 .17 3.89
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Note. (n = 159 youth). SSSC = Social Support Scale for Children; BASC INT CR = Behavioral Assessment System for Children, Second Edition, Internalizing Composite Score, Child Report; BASC PA CR = Behavioral Assessment System for Children, Second Edition, Personal Adjustment Composite Score, Child Report. Bootstrap iterations set at 5000 samples. All scores significant at p < .05.

Youths’ mean scores on the BASC Personal Adjustment Composite, however, were higher than those reported by typical age-matched youth, indicating better adjustment compared to youth surveyed during measure standardization. Results from independent sample t tests indicated that youths’ scores did not differ significantly on any of the BASC Composite scales, the BISC, the SSSC, or RO scores as a function of age (Children [under 12 years of age] vs. Adolescents [over 12 years of age]). Adolescent reporters had significantly lower mean scores on the Spirituality scale when compared to children (2.26 vs. 2.74 respectively; t [157] = 4.72, p < .01); therefore, age was maintained as a covariate in testing subsequent models. Youths’ reported means did not differ significantly as a function of gender for any of the study measures. Prior to testing of indirect effects as hypothesized, correlations between study variables were calculated. The results are presented in Table 2.

Table 2.

Summary of Intercorrelations, Means, Standard Deviations for Scores on Study Measures

Measure 1 2 3 4 5 6 7
1. SPIRIT -
2. RO .40** -
3. BISC .18* .53** -
4. SSSC .20** .37** .34** -
5. BASC INT CR −.10 −.26** −.29** −.52** -
6. BASC INN/HYP CR −.14 −.26** −.27** −.26** .66** -
7. BASC PA CR .22** .41** .41** .64** −.67** −.52** -
Mfoster (SDfoster) 2.46 (.58) 3.91 (.58) 3.63 (.72) 3.43 (.45) 53.17 (8.28) 51.62 (5.36)
Mres (SDres) 2.32 (.64) 3.81 (.62) 3.52 (.67) 3.24 (.56) 57.24 (8.17) 49.57 (6.34)
Mtotal 2.39 3.86 3.57 3.34 55.30 57.95 50.55
SDtotal .61 .60 .70 .52 8.45 9.62 5.97
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Note. (n = 159 participants). SPIRIT = Data-Derived Spirituality Scale (Factor 1), Child Report; RO = Data-Derived Relationship with Others Scale (Factor 2), Youth Report; BISC = Behavioral Inventory of Strategic Control, Direct Action Subscale; SSSC = Social Support Scale for Children; BASC INT CR = Behavioral Assessment System for Children, Second Edition, Internalizing Composite Score, Child Report; BASC INN/HYP CR = Behavioral Assessment System for Children, Second Edition, Inattention/Hyperactivity Composite Score, Child Report; BASC PA CR = Behavioral Assessment System for Children, Second Edition, Personal Adjustment Composite Score,

*

p < .05, and

**

p <.01.

T tests for Study Means: Residential Reporters vs. Foster Homes

Because study participants came from both residential centers and foster homes, the possibility that participant scores differed as a function of home location was explored. A number of independent samples t tests were conducted to determine whether participant mean scale scores differed as a function of location (residential vs. foster home). Standard bootstrapping sampling (with replacement) was utilized to generate empirical confidence intervals and to control for potential error rate inflation (5000 bootstrap samples generated). According to Preacher and Hayes (2008), bootstrapping techniques are often preferred over other methods that make assumptions about the shape of the sampling distribution. Results from these analyses are presented in Table 1.

Overall, youth from foster homes reported significantly higher SSSC and BASC Personal Adjustment scores when compared to youth from residential facilities (t [157] = 2.35, p < .05 and t [157] = 2.19, p < .05, respectively). Foster youth reported significantly lower BASC Internalizing problems than youth in residential facilities (t [157] = −3.12, p < .05). Thus, residential youth in the current study evidenced greater psychopathology and less perceived support and positive adjustment overall compared to youth from foster homes. As a result, placement status (residential or foster home) was included in subsequent analyses as a covariate.

Indirect Effect Analyses: Models with Multiple Predictors (Xs), Multiple Intervening Variables (Ms), and Single Outcome Variables (Y)

The models testing hypotheses 1–3 were tested utilizing Hays and Preacher’s (2014) MEDIATE macro for calculating indirect effects for models with multiple predictors and multiple intervening variables (with bootstrap resampling). This macro was designed for SPSS V. 20, and allows for the inclusion of multiple predictor variables (Xs), multiple intervening variables (Ms), and a single outcome variable (Y). For each analysis, a total of 5000 bootstrap samples (with replacement) were created, and 95% confidence intervals were generated for indirect effect estimates. Youth residential status and age were included within each of these models as covariates, as mean differences were observed for certain study variables as a function of these factors. Variables included in each separate analysis, as well as associated hypotheses, are listed in Table 3.

Table 3.

Proposed Tests of Indirect Effects for Study Variables, Utilizing Multiple Predictors (Xs) and MEDIATE Macro

Study Hypothesis Addressed Predictor Variables (Xs) Proposed Intervening Variables (Ms) Criterion Variable (Y)
1 SPIRIT, RO BISC, SSSC BASC ADAPT CR
2 SPIRIT, RO BISC, SSSC BASC INT CR
3 SPIRIT, RO BISC, SSSC BASC INN/HYP CR
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Note. SPIRIT = Data-Derived Spirituality Scale (Factor 1), Child Report; RO = Data-Derived Relationship with Others Scale (Factor 2), Child Report; BISC = Behavioral Inventory of Strategic Control, Direct Action Subscale; SSSC = Social Support Scale for Children; BASC INT CR = Behavioral Assessment System for Children, Second Edition, Internalizing Composite Score, Child Report; BASC INN/HYP CR = Behavioral Assessment System for Children, Second Edition, Inattention/Hyperactivity Composite Score, Child Report; BASC PA CR = Behavioral Assessment System for Children, Second Edition, Personal Adjustment Composite Score, Child Report.

Hypotheses: Spirituality and Relationship with Others (RO) scores as Multiple Predictors

BASC Personal Adjustment as the Outcome Variable

Hypothesis 1 predicted that BISC Scores (Coping) and SSSC scores (Social Support) would have significant and independent indirect effects on a) the relation between Spirituality (X1) and child reported BASC Personal Adjustment scores and b) Relationship with Others (RO; X2) scale scores and child reported BASC Personal Adjustment scores. Participant residential status (foster care vs. residential center) and participant age (child vs. adolescent) were included as covariates within the overall model. The inclusion of these variables accounted for approximately 27% of the variance in BASC Personal Adjustment scores (R2 = .27, F [4, 154] = 14.12, p < .001; see Figure 1). No significant direct effects were found for the relation between Spirituality and BISC scores (a11 pathway), or for the relation between Spirituality and SSSC scores (a12 pathway). Furthermore, no significant direct effect was found for the relation between Spirituality and BASC Personal Adjustment scores (c′1 pathway). Because none of these relations were significant, the subsequent results focus on the effects found for RO scale scores (X2). Due to the fact that Spirituality (X1) was uncorrelated with either effector variable (BISC or SSSC), it was excluded from discussion (and representation) in subsequent models and figures.

Figure 1.

Figure 1

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Tests of Indirect Effects of the BISC (M1) and SSSC (M2) on the Relation Between Spirituality (X1), Relationship with Others (X2), and BASC Youth Reported Personal Adjustment Scores (Y).

A significant direct effect was found for the relation between RO scores and BASC Personal Adjustment scores (b = 1.78, t[154] = 2.49, p < .05; c′2 pathway). Significant direct effects were found for the relation between RO scores and BISC scores (b = .62, t[154] = 7.20, p <.01; a21 pathway) and also for the relation between RO scores and SSSC scores (b = .29, t[154] = 4.23, p <.01; a22 pathway). Significant direct effects were also found for the relation between BISC scores and BASC Personal Adjustment scores (b = 1.28, t[154] = 2.21, p < .05; b1 pathway), as well as for the relation between SSSC scores and BASC Personal Adjustment scores (b = 5.89, t[154] = 8.19, p < .01; b2 pathway). Tests of indirect effects for a21b1 emerged as significant (the 95% CI, .05 to 1.61 [SE = .39], did not contain zero) indicating the presence of an indirect effect for BISC scores on the relation between RO scores and BASC Personal Adjustment. A significant indirect effect was also found for a22b2, indicating that SSSC scores significantly affected the relation between RO scores and BASC Personal Adjustment scores (the 95% CI, .93 to 2.67 [SE = .44], did not contain zero). Overall, the total effect of RO scores on BASC Personal Adjustment scores emerged as significant (b = 4.30, t[154] = 5.76, p < .01; c2 pathway = c′2 + a21b1 pathway + a22b2 pathway). Hypothesis 1 was only partially supported (spirituality not supported); however, significant direct, indirect, and total effects were found for the relation between RO and BASC Personal Adjustment scores, through the BISC and SSSC. The results are depicted in Figure 1.

BASC Internalizing Problem Scores as the Outcome Variable

The previous analysis was repeated using youth reported BASC Internalizing scores as the outcome variable. The inclusion of these variables accounted for approximately 12% of the variance in BASC Internalizing scores (R2 = .12, F [4, 154] = 5.13, p < .001). Participant residential status emerged as a significant covariate within the overall model (b = 2.60, t[153] = 2.23, p < .05). Because none of the relations for Spirituality (X1) were significant (as in the previous analysis), the subsequent results focus on the effects found for RO scale scores (X2).

No significant direct effect was found for the relation between RO scores and BASC Internalizing scores (c′2 pathway). Significant direct effects were found for the relation between RO scores and BISC scores (b = .62, t[154] = 7.20, p <.01; a21 pathway) and also for the relation between RO scores and SSSC scores (b = .29, t[154] = 4.23, p <.01; a22 pathway). While no significant direct effects were found for the relation between BISC scores and BASC Internalizing scores (b1 pathway), a significant direct effect was found for the relation between SSSC scores and BASC Internalizing scores (b = −7.42, t[154] = −6.07, p < .01; b2 pathway). Although tests of indirect effects for a21b1 emerged as nonsignificant, a significant indirect effect was found for a22b2, indicating that SSSC scores affected the relation between RO scores and BASC Internalizing scores (the 95% CI, −3.47 to −1.06 [SE = .61], did not contain zero). Overall, the total effect of RO scores on BASC Internalizing scores emerged as significant (b = −3.58, t[154] = −3.08, p < .01; c2 pathway = c′2 + a21b1 pathway + a22b2 pathway). Hypothesis 2 was only partially supported; SSSC scores significantly affected the relation between RO and BASC Internalizing scores. Results are depicted in Figure 2.

Figure 2.

Figure 2

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Tests of Indirect Effects of the BISC (M1) and SSSC (M2) on the Relation Between Spirituality (X1), Relationship with Others (X2), and BASC Youth Reported Internalizing Scores (Y).

BASC Inattention/Hyperactivity Scores as the Outcome Variable

The previous analysis was repeated using youth reported BASC Inattention/Hyperactivity scores as the outcome variable. The inclusion of these variables accounted for approximately 8% of the variance in BASC Inattention/Hyperactivity scores (R2 = .08, F [4, 154] = 3.37, p < .05). Because none of the relations for Spirituality (X1) were significant (as in the previous analyses), the subsequent results focus on the effects found for RO scale scores (X2).

No significant direct effect was found for the relation between RO scores and BASC Inattention/Hyperactivity scores (c′2 pathway). Significant direct effects were found for the relation between RO scores and BISC scores (b = .62, t[154] = 7.20, p <.01; a21 pathway) and also for the relation between RO scores and SSSC scores (b = .29, t[154] = 4.23, p <.01; a22 pathway). However, no significant direct effects were found for the relation between BISC scores and BASC Inattention/Hyperactivity scores (b1 pathway), or for the direct relation between SSSC scores and BASC Inattention/Hyperactivity scores (b2 pathway). Tests of indirect effects for a21b1 and a22b2 emerged as nonsignificant, indicating the absence of indirect effects for both BISC and SSSC scores on the relation between RO scores and BASC Inattention/Hyperactivity scores. Overall, the effect of RO scores and intervening variables on BASC Inattention/Hyperactivity scores emerged as significant (b = −3.76, t[154] = −2.79, p < .01; c2 pathway = c′2 + a21b1 pathway + a22b2 pathway). However, hypothesis 3 was not supported; neither BISC nor SSSC scores produced significant indirect effects on the relation between RO scores and BASC Inattention/Hyperactivity scores.

Overall, partial support was found for hypotheses 1 and 2. Relations hypothesized between spirituality, intervening variables, and youth outcomes were not significant in any of the models tested; however, results indicated significant indirect relations between RO scores and BASC adaptive outcomes (1) and BASC internalizing problems (2), occurring through SSSC scores. Additionally, significant direct and indirect relations were found to exist between RO and BASC adaptive scores, occurring through BISC scores (1). Hypothesis 3 (examination of the impact of these variables on BASC externalizing problems) was not supported.

Discussion

Youth in foster care appear to carry a disproportionate risk for negative mental health outcomes when compared to typical youth (Oswald, Heil, & Goldbeck, 2010). The current study examined how two mechanisms, coping and perceived social support, potentially affect the relation between spirituality and outcomes (both adaptive and maladaptive) in foster youth. The present study found support for previous findings, and also raises new questions about how spirituality might operate to impact the emotional and behavioral functioning of youth in care.

Spirituality and Relations with Others: Effects on Adaptive Outcomes

Few prior studies have examined relations between spirituality and adaptive outcomes in youth. Dowling et al. (2004) found positive effects for spirituality on adaptive behavior in non-maltreated youth, providing preliminary evidence that spirituality may affect positive behavioral outcomes. King and Furrow (2004) produced similar findings, in that non-maltreated youth who reported higher participation in spiritual activities and engagement in spiritual practice demonstrated higher empathy and greater moral understanding than their counterparts who endorsed lower levels of spirituality. The current study attempted to expand previous findings by examining whether these relations also hold true for youth in foster care.

Findings from the current study are consistent with the aforementioned studies, in that significant relations were found between spirituality and youth adaptive functioning. However, contrary to previous research, the effects of spirituality emerged as nonsignificant in the final, indirect effect model test (Hypothesis 1). Rather than finding robust effects for spirituality, one unexpected finding was that relationships with others were strongly related to adaptive outcomes. In fact, compared with spirituality in the indirect effect model tests, results suggest that relationship with others accounted for a greater portion of the variance in adaptive outcomes than spirituality in youth exposed to maltreatment. Furthermore, relations with others impacted adaptive behavior through a number of significant pathways (directly and indirectly through both coping and social support). This finding was unique, suggesting that relationships with others affect not only perceptions of social support for youth exposed to maltreatment, but also their level of individual coping in response to stressors they might experience. One interpretation for this finding is that youths’ reports of their positive relationships with others relates to their perception of resources available to cope with extant stressors in their lives. This interpretation is consistent with Zielinski and Bradshaw’s risk/protective factor model, in that both individual (coping) and contextual factors (social support) can affect youth outcomes (2006).

King and Furrow (2004) suggested that viewing and participating in trusting, empathic, and supportive interactions with others (which the authors called social capital) was related to a more highly developed sense of morality compared to youth who did not endorse these views of and experiences with positive relationships. In this regard, the results of the current study are supported by an established body of research highlighting the connection between positive views of relating to others, the performance of behaviors building social cohesion, and positive youth outcomes. Consistent with findings by Crawford, Wright, and Masten (2006), it is possible that performance of these socially cohesive practices, association with peers and adults who value social cohesion, and experiencing supportive and empathic networks (as well as positive role models) are all benefits of spiritual practice that ultimately promote adaptive functioning in maltreated youth. For example, Anthonysamy and Zimmer-Gembeck (2007) noted that maltreated youth often demonstrate a range of antisocial activity (e.g., aggressive behaviors) that likely impact social functioning. Given that social cohesion and harmony are fundamental tenets of a number of spiritual and religious belief systems, it is possible that participation with prosocial peers and models in the religious context might impact aggressive behavioral tendencies. Rather than spiritual beliefs having importance in impacting outcomes, the application of beliefs within the context of social relationships are potentially a key factor affecting functioning for maltreated youth.

Spirituality and Relations with Others: Effects on Internalizing Outcomes

Hypotheses 2 predicted significant relations between spirituality scores and internalizing outcomes. These hypotheses were only partially supported, in that relationship with others (and not spirituality) was predictive of internalizing symptoms. The results differ from previous studies (Cotton et al., 2006; Hodge, Cardenas, & Montoya, 2001), which have noted that spirituality significantly impacts internalizing functioning in youth. For example, Kim (2008) found that importance of faith provided significant protective effects against internalizing symptoms, at least for girls exposed to maltreatment. However, Dew et al. (2010) noted that the utilization of negative religious coping, characterized by a belief that God or a Higher Power is punitive and that adverse events happen as part of divine mandate, could relate to hopelessness and depressive cognitive styles. Thus, negative religious views and depressive symptoms could be part of the same underlying lens with which certain youth see the world, in that these youth tend to view numerous events as consistently negative and unchangeable.

Null findings in the relation between spirituality and internalizing outcomes obtained in the current study can be explained in a number of ways. First, it is possible that how youth apply spiritual beliefs to understanding maltreatment experiences, rather than the specific spiritual beliefs they hold, ultimately relate to internalizing symptoms. For instance, the current study asked youth about their endorsement of spiritual beliefs, but did not ask youth about these beliefs in relation to specific life events (e.g., maltreatment experiences), or how these beliefs might influence their subsequent future expectations. It is possible that the ways in which spiritual beliefs affect their explanations for events and their expectations for future events, rather than their general endorsements of spiritual beliefs, are the active determinants in predicting internalizing symptoms. For example, Warner, Mahoney, and Krumrei (2009) found that, among a sample of typical youth, level of religiosity was not the factor in determining adjustment in youth following psychosocial stress (e.g., divorce). Rather, it was the application of a specific type of religious explanation for the event (e.g., viewing the event as a “divine” punishment and thus unchangeable) that led to subsequent depressive and anxious symptoms. Because the current study did not examine whether spiritual explanations were used by youth to explain their maltreatment experiences or how these beliefs might affect expectations for future events, it is difficult to determine how spirituality might operate with other explanatory processes and attempts at making meaning of maltreatment experiences for youth in the current study.

An important and unique finding from the current study was that youths’ relationship with others affected internalizing behaviors, and also that social support exerted significant indirect effects on this relation. This finding is also supported by previous research, in that various dimensions of social support have been found to predict youth depressive behaviors even above and beyond the effects of spirituality and religious functioning (Dew et al., 2010). However, findings from the current study expand previous research by suggesting that both relating to others in socially cohesive ways (e.g., relationships with others) and endorsing strong perceptions of social support relate to lower internalizing symptoms for these youth. This finding provides evidence that both internal factors (e.g., youth perceptions of support) and external behaviors (e.g. forgiving others, being thankful, and following rules) can affect functioning for maltreated youth; it also underscores the overall importance that positive relationships can have in ameliorating the negative impact of maltreatment experiences for youth in care. Stronach et al. (2011) provided evidence for the notion that maltreated youth exhibit poorer attachment quality and more negative representations of relationships than their non-maltreated counterparts. Other lines of research have demonstrated that maltreated youth demonstrate poorer social functioning compared to youth without maltreatment histories (Alink, Cicchetti, Jungmeen, & Rogosch, 2012). Although tested only for a limited set of relational factors within the current study, findings preliminarily suggest (alongside other studies) that understanding and addressing social factors (e.g., perceptions, behaviors, and representations) might be particularly salient in altering the negative developmental effects of maltreatment experiences on internalizing outcomes.

Spirituality and Relations with Others: Effects on Externalizing Outcomes

Hypothesis 3 predicted significant relations between spirituality and externalizing outcomes. The results obtained were in the opposite expected direction, and contrary to a body of literature that has found significant effects for spirituality on externalizing behaviors (Hodge et al., 2001). For instance, Smith (2003b) summarized a number of studies demonstrating associations of religion and spirituality with lower substance use and delinquency in adolescents. However, these studies were conducted with non-maltreated youth, and the generalizability of those results to youth in foster care is unclear. The current study tested these relations for youth in foster care, presenting an important contribution to the research literature given the higher risk of foster youth for delinquent behavior compared to non-maltreated youth (Courtney, Piliavin, Grogan-Kaylor, & Nesmith, 2001).

At least one study that has been conducted with maltreated youth has produced findings similar to the current study. Results from a study by Kim (2008) suggested that, while spirituality may carry protective benefits for non-maltreated youth, these effects did not significantly impact externalizing problems in youth exposed to maltreatment. However, unlike the current study, Kim relied on church attendance as a proxy for spirituality, likely overlooking the importance of internal facets of spirituality. Our results suggest, first and foremost, that caution should be used in extrapolating findings from spirituality research conducted on samples of non-maltreated youth to those in foster care. Second, these findings provide support for the existence of multiple potential pathways by which youth exposed to maltreatment and other youth arrive at similar outcomes; specifically, results suggest that spirituality might not provide protective benefits to all youth, at least not by the mechanisms examined within the current study or with externalizing behaviors considered as an outcome.

Previous studies have suggested that both coping and social support provide protective benefits for non-maltreated youth, relating to lower levels of externalizing behaviors. Grant et al. (2006) reviewed a wide body of literature highlighting the numerous cognitive variables, including coping, that can impact myriad behavioral outcomes for non-maltreated youth. These authors note that, for these youth, coping and stress likely interact to influence additional cognitive characteristics (such as attribution and appraisals) that affect how youth manage stressors. Although these studies have provided evidence for the positive effects of coping and social support for non-maltreated youth, far less research has been conducted examining the impact of these variables for maltreated youth on problem behaviors. While evidence exists that coping and social support provide protective benefits for youth exposed to both community violence and familial violence (Brady, Gorman-Smith, Henry, & Tolan, 2008), the current study suggests that these relations also hold true for maltreated youth in foster care.

Limitations and Future Directions

Results obtained from the current study should be interpreted in light of certain limitations. First, the research design and statistical methods employed in the current study were correlational; causality between predictors and criterion variables cannot be assumed without first establishing temporality, which is the occurrence of one variable predicting significant change in another variable over time. Second, interpretations of the current results may be limited by lack of a comparison group of non-maltreated youth. Inclusion of a control group of age, gender, and ethnically matched children would provide stronger evidence that the observed results were specific to youth in foster care or generalizable to all youth. Third, the measure of internalizing and externalizing symptoms was self-report and youth may have underreported their symptoms. Despite the BASC-2 being a highly reliable measure with validity indices that indicate overly positive or implausible reporting, future research would benefit from assessing symptoms using multiple reporters. Finally, many of the measures included were lengthy and therefore had the potential to introduce fatigue effects for participating youth. Although validity indices were examined for response consistency and internal reliability was found to be moderate to high for all measures, participants may have found answering so many questions unwieldy. Attempts to minimize fatigue included giving participants multiple breaks and having multiple data collection sessions if participants became tired and needed to split up the measures into separate days.

Notwithstanding these limitations, the current study contributed to the advancement of the study of spirituality and youth in a number of ways. First, the current study provided a systematic investigation of these constructs for youth in foster care exposed to maltreatment, extending the applications of previous theories to a group of at-risk youth. This research allows tests of extant theories to examine their generalizability to select populations at risk for negative outcomes, such as youth in care. Second, the current study contributed to the literature by further illuminating how the ways in which foster youth cope with their experiences and how they perceive social relationships can ultimately affect both positive and negative mental health outcomes. Finally, and perhaps most importantly, the current study demonstrated that these factors affect adaptive functioning in youth, prompting additional consideration of how beliefs and youths’ social resources could be useful in understanding positive outcomes for youth exposed to maltreatment.

The current study raised a number of additional areas for future inquiry. First, further examination of how foster youth utilize spiritual beliefs to manage acute stressors and practical adversities of day-to-day living (e.g., changing foster homes) could provide insight into internal processes used by youth to make meaning of their experiences. Disentangling these cognitive processes by examining their unique contributions in affecting mental health outcomes could provide clarity to how spirituality ultimately impacts at-risk youth. Second, more research is needed to clarify which aspects of social support ultimately affect the relation between spirituality and mental health outcomes. It is possible that the quantity of support (e.g., number of caregivers), the quality of support (e.g., existence of invested and available caregivers), the stability of support (existence of long-term, dependable relationships), and the source of support (e.g., teachers, peers, and parents) can impact the relation between spirituality and youth outcomes. Finally, it is important to systematically study whether any of the above relations, including those tested in the current study, are impacted by various dimensions inherent to maltreatment experiences, including type, frequency, chronicity, and severity of abuse. Although maltreatment was assessed within the context of our larger study, these results were not included in the current analyses; factors specific to the quality of the abuse experience itself would be edifying to include in future studies to examine how qualities of maltreatment experiences can impact the pathways/constructs observed.

Acknowledgments

Funding: The current project was made possible by funding from the National Institutes of Mental Health, RO1 grant MH079252-03

A special thanks to the entire Studying Pathways to Adjustment and Resilience in Kids (SPARK) team and research assistants.

Contributor Information

Kalani Makanui, Didi Hirsch Mental Health Services.

Yo Jackson, Pennsylvania State University.

Stephanie Gusler, University of Kansas.

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