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. Author manuscript; available in PMC: 2020 Nov 1.
Published in final edited form as: Psycholog Relig Spiritual. 2017 Nov 27;11(4):408–416. doi: 10.1037/rel0000146

Spirituality and Multiple Dimensions of Religion Are Associated with Mental Health in Gay and Bisexual Men: Results From the One Thousand Strong Cohort

Jonathan M Lassiter 1,5, Lena Saleh 1, Christian Grov 1,2, Tyrel Starks 1,3,4, Ana Ventuneac 1, Jeffrey T Parsons 1,3,4,6
PMCID: PMC6892427  NIHMSID: NIHMS922115  PMID: 31803345

Abstract

The purpose of this study was to determine the association between religion, spirituality, and mental health among gay and bisexual men (GBM). A U.S. national sample of 1,071 GBM completed an online survey that measured demographic characteristics, religiosity, religious coping, spirituality, and four mental health constructs (i.e., depressive symptoms, rejection sensitivity, resilience, and social support). Hierarchal linear regressions determined the associations between each mental health construct, demographic variables, and the spirituality and religion variables. Controlling for demographic characteristics, spirituality was negatively associated with depression and rejection sensitivity, and positively associated with resilience and social support (all p < .001). Religiosity was positively associated with rejection sensitivity (p < .05) and negatively associated with resilience (p < .01). Religious coping was positively associated with depression (p < .001) and rejection sensitivity (p < .05) and negatively associated with resilience (p < .05) and social support (p < .05). The interaction of spirituality with religion was significantly associated with all mental health variables. In general, religious GBM with higher levels of spirituality had better mental health outcomes. Spirituality was significantly positively associated with positive mental health outcomes and negatively associated with negative ones. Religion—solely expressed through behaviors and lacking the functional components of spirituality such as meaning-making and connection to the sacred—was associated with mental health problems among GBM. Public health interventions and clinical practice aimed at decreasing negative mental health outcomes among GBM may find it beneficial to integrate spirituality into their work.

Keywords: spirituality, religion, mental health, gay men, bisexual men

Introduction

Over the past two decades, researchers have consistently found an association between spirituality, religion, and a wide range of physical and mental health outcomes in the general population. However, most of this research has been done with presumed heterosexual samples. When researchers do examine spirituality and religion in the lives of sexual minorities, the focus has often been on how these factors are associated with homonegativity (Barton, 2010; Walker & Longmire-Avital, 2013). Furthermore, little is known about how specific dimensions of spirituality and religion (i.e., religiosity – religious behaviors – and religious coping – “how the individual is making use of religion to understand and deal with stressors” Pargament, Koenig, & Perez, 2000, p. 521) impact both positive and negative mental health outcomes for sexual minorities. Specifically, studies often focus on sexual minorities’ spiritual and religious behaviors (such as frequency of church attendance). This emphasis on the behavioral aspects of spirituality and religion overlooks the functional aspects (i.e., how religion and spirituality influence one’s life in personal and social ways) that are crucial to understanding the mechanisms of spirituality and religion’s impact on health (Ellison & Levin, 1998). Thus, possible specific mechanisms of religion and spirituality’s associations with both positive and negative mental health outcomes for sexual minorities remain unknown. This study sought to address this gap in the literature by investigating how spirituality and multiple dimensions of religion influence both positive and negative mental health outcomes for a national sample of HIV-negative gay and bisexual men (GBM).

Defining Religion and Spirituality

Religion and spirituality are overlapping but distinct constructs that focus on one’s relationship with the sacred (Hill et al., 2000; Oman, 2013; Zinnbauer et al., 1997). Spirituality refers to “the search for the sacred” (Pargament, Mahoney, Exline, Jones, & Shafrankse, 2013, p. 14), where “search” refers to “the ongoing journey of discovery, conservation, and transformation” (p. 15) and “sacred” refers “not only to concepts of God and higher powers but also to other aspects of life that are perceived to be manifestations of the divine or imbued with divinelike qualities, such as transcendence, immanence, boundlessness, and ultimacy” (Pargament et al., 2013, p. 14). In turn, “religion” is defined as “the search for significance that occurs within the context of established institutions that are designed to facilitate spirituality” (Pargament et al., 2013, p. 15). Whereas spirituality is most often defined as a multidimensional and transcendent relationship with the sacred that is free of boundaries, religion tends to be defined by its boundaries in its creation of specific rules and criteria for engagement with the sacred (Miller & Thoresen, 2003). In addition, religion also embraces nonspiritual, social concerns such as politics and economics, whereas spirituality is most often viewed as a unique experience that varies for each person (Miller & Thoresen, 2003).

Spirituality and religion have traditionally been treated either as behavioral or functional in health research (Oman, 2013). Specifically, health research has either focused on how religious behaviors (religiosity) and spiritual beliefs relate to health outcomes (behavioral focus) or how spirituality and religion facilitate coping and meaning-making related to illness (functional focus). To address the functional components of religion, religious coping has recently begun to be more studied (Pargament et al., 2000). Religious coping examines how people use their relationships with the sacred and the established sacred institutions to navigate stressful events (Ano & Vasconcelles, 2005). Researchers have found this to be an important health-related cultural factor among both heterosexuals and GBM (Woods, Antoni, Ironson, & Kling, 1999).

Spirituality and Religion’s Associations with Mental Health in General Populations

Several studies have investigated the specific influences of distinct components of spirituality and religion on mental health in general (presumed heterosexual) samples. These studies have generally found mixed results (Hackney & Sanders, 2003; Masters & Spielmans, 2007; Underrainer, Lewis, & Fink, 2014). A recent systematic review found that most studies of religion, religiosity, spirituality and mental health demonstrated an inverse association between religious and spiritual involvement and mental disorders (72%), with limited studies demonstrating mixed results (19%) and more mental disorders (5%) (Bonelli & Koenig, 2013). Greater spirituality and religion was associated with lower levels of depression (Bonelli & Koenig, 2013; Cotton, Zebracki, Rosenthal, Tsevat, & Drotar, 2006; Power & McKinney, 2013), posttraumatic stress (Arevalo, Prado, & Amaro, 2008), lower risk of suicide (Cotton et al., 2006), and less perceived stress (Arevalo et al., 2008). Religious involvement has also been found to be associated with positive affect, better quality of life, greater life satisfaction and higher morale (Abu-Raiya, 2013; Shah et al., 2011).

Beyond the positive impact of these factors on health, studies have shown that they can also have negative consequences on health. Religion (particularly negative religious coping [e.g., passive reliance on the sacred; feeling abandoned by the sacred] and extrinsic religious orientation) and spirituality, to a lesser extent, have also been associated with poor mental health outcomes (Olson, Trevino, Geske, & Vanderpool, 2012; Rippentrop, Altmaier, Chen, Found, & Keffala, 2005; Smith, McCullough, & Poll, 2003). Taken together, these findings demonstrate the duality of spirituality and religion; they are both risk and protective factors for health. Although these findings are important, they were demonstrated in presumed heterosexual samples; the dual impact of religion and spirituality for the mental health of gay and bisexual men is an area for exploration.

Spirituality, Religion, and Mental Health among GBM

Given the homonegative tone of Abrahamic religious traditions, such as Christianity, Islam and Judaism, research on religion among GBM has largely focused on its negative association with mental health (Schuck & Liddle, 2001). Most Abrahamic religious traditions, to varying degrees, have denounced same-sex behaviors and described these behaviors as perverse and sinful (Barnes & Meyer, 2012; Morrow, 2003; Sherkat, 2002; Zea & Nakamura, 2014). In such contexts, religion has been found to be strongly correlated with negative attitudes toward GBM (Battle & Lemelle, 2002; Herek, 2000; Pitt, 2010). Such attitudes contribute to homonegative religious experiences (e.g., being shunned from religious communities) that negatively affects GBM’s mental health. For example, homonegative religious experiences have been found to be associated with internalized homophobia, lower self-esteem, and higher stress over sexual orientation (Barnes & Meyer, 2012; Hamblin & Gross, 2014; Lassiter & Parsons, 2015; Shilo & Savaya, 2012; Sowe, Brown, & Taylor, 2014). Unfortunately, these homonegative aspects of religious and spiritual experiences may contribute to mental health disparities (e.g., higher risks of substance abuse, suicide, depression, and anxiety) among sexual minorities (King et al., 2008; Semlyen, King, Varney, & Hagger-Johnson, 2016).

Considerably less research has examined the positive influences of religion and spirituality on the lives of GBM. Some qualitative studies, mostly focused on GBM of color (Foster, Arnold, Rebchook, & Kegeles, 2011; Jeffries, Dodge, & Sandfort, 2008; Jeffries et al., 2014; Seegers, 2007) have found that religion and spirituality act as protective factors that add meaning to the lives of GBM. In addition, some quantitative studies have found that religion and spirituality were associated with positive mental health outcomes such as psychological adjustment, fewer depressive symptoms, and less substance use among GBM (Coleman, 2003; Kipke et al., 2007; Lease, Horne, & Noffsinger-Frazier, 2005; Tan, 2005; Woods, Antoni, Ironson, & Kling, 1999). Although there is a growing body of literature examining the dual impact of religion and spirituality among GBM, the majority of research in this area tends to be pathologically oriented. Furthermore, studies focused on spirituality—as a separate construct from religion that encompasses the functional components of spirituality such as meaning-making and connection to the sacred—and mental health outcomes are sparse. This is unfortunate given that GBM may consider spirituality more important than religion in their lives (Halkitis et al., 2009).

Current Study

This study aimed to address methodological issues and gaps in the literature pertaining to GBM, religion, spirituality, and mental health outcomes. Associations of spirituality and multiple dimensions of religion (specifically, religiosity and religious coping) with both negative (depression and rejection sensitivity) and positive (resilience and social support) mental health outcomes in a U.S. national sample of HIV-negative GBM were examined. In doing so, the goal was to extend existing research on the associations of spirituality and religion with mental health among GBM beyond that of negative mental health outcomes, to also include examination of variables that may be beneficial to mental health. Informed by Meyer’s minority stress model (2003), we hypothesized that religion and religious coping will act as minority stressors (given the homonegative components of Abrahamic religious traditions) and directly influence both positive and mental health outcomes. Specifically, we proposed that religion and religious coping will be positively associated with depression and rejection sensitivity and negatively associated with resilience and social support. Furthermore, we hypothesized that spirituality will be directly associated with mental health outcomes as well as act as a coping mechanism for GBM in the presence of possible negative religious experiences (minority stressors) and moderate the impact of religion on GBM’s mental health (see Figures 1a and 1b).

Figure 1.

Figure 1

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Figure 1a. Hypothesized model of direct and indirect effects of spirituality on negative mental health outcomes

Figure 1b. Hypothesized model of direct and indirect effects of spirituality on positive mental health outcomes

Method

Participants and Procedures

The One Thousand Strong cohort is a longitudinal study following a U.S. national sample of GBM for a period of three years to better understand resilience and HIV syndemics among HIV-negative GBM. Analyses for the present paper are based on baseline data. Participants were identified via Community Marketing and Insights, Inc. (CMI) panel of over 45,000 LGBT individuals, over 22,000 of whom are gay and bisexual men throughout the U.S. Through our partnership, CMI was utilized to identify participants and briefly screen them for eligibility. Those deemed preliminary eligible had their contact information shared with the team, and we then independently followed up full enrollment and longitudinal assessment. Details regarding enrollment for the panel have been describe elsewhere [BLINDED].

To be eligible, participants had to reside in the U.S., be at least 18 years of age, be biologically male and currently identify as male, identify as gay or bisexual, report having any type of sex (i.e., oral, anal, mutual masturbation) with a man in the past year, self-identify as HIV-negative, be able to complete assessments in English, have access to the Internet such to complete at-home online assessments, have access to a device that was capable of taking a digital photo (e.g., camera phone, digital camera), have an address to receive mail that was not a P.O. Box, report residential stability (i.e., have not moved more than twice in the past 6 months) and complete both at-home self-administered rapid HIV antibody testing (those testing positive were not included in the panel), as well as self-collected urine and rectal sampling for STI testing. Please see [BLINDED] for a thorough rationale for these eligibility criteria. Enrollment was conducted over a period of 6 months (April 2014–October 2014) to maintain sufficient staffing resources to guide participants through the enrollment milestones (e.g., mailing HIV/STI testing kits, following up with participants). The [BLINDED] Institutional Review Board approved study procedures.

Measures

Demographics

Participants reported their race and ethnicity, educational level, relationship status, income, sexual orientation identity label, current geographical region of residence, and age.

Outcome variables

Depressive symptoms were evaluated using the Center for Epidemiological Studies-Depression Scale (CES-D; Radloff, 1977). This 20-item scale with response options that range from 0 (rarely or none of the time) to 3 (most or all of the time) assesses a participant’s experience of the physiological, cognitive, and psychological symptoms of depression. The item responses were summed for a total score. Higher scores indicate more depressive symptoms experienced by the participant (α = .93).

The Rejection Sensitivity Questionnaire (Downey & Feldman, 1996) was used to measure rejection sensitivity, which has been conceptualized as a person’s general sensitivity to interpersonal rejection that is neither status-based nor specific to any type of context. The scale contains nine vignettes that assess a participant’s level of anxiety and expectancy related to that particular vignette. The participant rated his anxiety and expectancy on a Likert scale that ranges from 1 (very unconcerned/very unlikely) to 6 (very concerned/very likely). Higher scores indicate higher levels of rejection sensitivity (α = .67).

Resilience was measured with the 10-item Connor-Davidson Resilience Scale (Campbell-Sills & Stein, 2007). Participants rated their agreement with items on a scale of 0 (not true at all) to 4 (true nearly all of the time). Higher scores indicate more resilience (α = .91).

Social support was assessed with the Multidimensional Scale of Perceived Social Support (MSPSS; Zimet et al., 1988). The scale has 12 items that assess the level of social support one perceives he receives from his significant other, family members, and friends on a scale that ranges from 1 (very strongly disagree) to 6 (very strongly agree). Higher scores indicate higher levels of perceived social support (α = .92).

Predictor variables

Spirituality and religiosity were measured using the Ironson-Woods Spirituality/Religiousness Index (Ironson et al., 2002). This measure was developed and validated with a racially diverse sample (Ironson et al., 2002) and has since successfully predicted a range of mental health outcomes including depression and social support (Bekelman, Parry, Curlin, Yamashita, Fairclough, & Wamboldt, 2010; Monod, Brennan, Rochat, Martin, Rochat, & Bula, 2011). It was used because of its validation with both LGBT and heterosexual racially diverse people as well as its inclusion of subscales to assess both spirituality and religion. The Ironson-Woods Sense of Peace subscale (Ironson et al., 2002) is a 9-item questionnaire that assesses how participants’ spirituality functions to help them make meaning of their lives and feel connected to the sacred. Sample items include “My beliefs give me a sense of peace” and “My beliefs help me feel I have a relationship or a connection with a higher form of being.” The participant rated his agreement with the item on a scale of 1 (strongly disagree) to 6 (strongly agree). Higher scores suggest higher levels of spirituality (α = .95).

Religiosity was assessed using the Ironson-Woods Religious Behavior subscale (Ironson et al., 2002). It is a 5-item subscale that assesses participants’ involvement in religious behaviors. Sample items include “I attend religious services” and “I discuss my beliefs with others who share my belief.” The participant rated his agreement with the item on a scale of 1 (strongly disagree) to 6 (strongly agree). Higher scores suggest higher levels of religiosity (α = .84).

Religious coping was measured with the Religious Coping subscale of a modified version of the COPE (Carver et al. 1989). There are four items on the subscale. Sample items include, “I try to find comfort in my religion or spiritual beliefs,” and “I seek God’s (or a higher power’s) help.” The participant rated his agreement with the statement on a scale of 1 (I usually don’t do this at all) to 4 (I usually do this a lot). Higher scores indicate higher levels of religious coping (α = .95).

Data Analysis

Descriptive analyses for demographic characteristics, spirituality and religious variables, and mental health outcome variables were performed. Four linear regressions were conducted, one for each of the four mental health outcomes of interest: depressive symptoms, rejection sensitivity, resilience, and social support. The assumptions of multiple regression were assessed and met. Analyses were conducted using SPSS 22.

Results

Shown in Table 1, the sample was predominately comprised of White (71.2%), gay-identified (95.0%), college educated (55.7%), and single (51.3%) men with a mean age of 40. The most endorsed residential location was the Southeastern region of the United States (35.2%). In total, 46.3% reported an income of $50,000 or more a year.

Table 1.

Demographic Characteristics (N = 1071)

n %
Race/Ethnicity
 Black 83 7.7
 Latino 135 12.6
 White 763 71.2
 Other/Multiracial 90 8.4
Education
 No college degree 474 44.3
 College degree 597 55.7
Relationship Status
 Single 549 51.3
 In a relationship 522 48.7
Income
 Less than 20K 213 19.9
 20K to 49K 362 33.8
 50K or more 496 46.3
Sexual Orientation
 Gay 1017 95.0
 Bisexual 54 5.0
Geographic Region
 Southeastern 377 35.2
 Northeastern 204 19.0
 Midwest 192 17.9
 West 297 27.7
 U.S. Possession 1 0.1
M SD
Age (Range = 18 – 79) 40.2 13.8
Spirituality (Range = 9 – 45) 27.8 11.2
Religiosity (Range = 5 – 25) 11.2 5.7
Religious Coping (Range = 4 – 16) 7.0 3.8
Depression (Range = 0 – 56) 16.5 0.3
Rejection Sensitivity (Range = 1 – 26) 9.1 0.1
Resilience (Range = 2 – 40) 29.5 0.2
Social Support (Range = 12 – 84) 62.2 0.5
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Multivariate Analyses

Table 2 displays the results of the linear regression analyses for the four mental health outcomes. After controlling for demographic variables, spirituality was negatively associated with depression and rejection sensitivity, and positively associated with resilience and social support (all p < .001). Religiosity was positively associated with rejection sensitivity (p < .05) and negatively associated with resilience (p < .01). Religious coping was positively associated with depression (p < .001) and rejection sensitivity (p < .05) and negatively associated with resilience (p < .05) and social support (p < .05).

Table 2.

Influences of Spirituality, Religiosity, and Religious Coping on GBM’s Mental Health Outcomes

Depression Rejection Sensitivity
Predictor b 95% CI β R2 b 95% CI β R2
Spirituality −.39*** −.49 – .29 −.38 −.09*** −.12 – .06 −.31
Religiosity .16 −.05 – .37 .08 .07* .01 – .13 .12
Religious coping .68*** .39 – .98 .23 .12* .03 – .20 .13
Spirituality X Religiosity −.03*** −.04 – −.02 −.16 −.01*** −.01 – .00 −.14
.15 .10
Resilience Social Support
b 95% CI β R2 b 95% CI β R2
Spirituality .25*** .20 – .31 .44 .45*** .32 – .57 .33
Religiosity −.16** −.28 – −.04 −.14 −.17 −.43 – .10 −.06
Religious coping −.18* −.34 – −.01 −.10 −.39* −76 – .00 −.09
Spirituality X Religiosity .02*** .01 – .03 .16 .03** .01 – .04 .10 x
.12 .22
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Note. Race, ethnicity, education, relationship status, income, sexual orientation, geographic region, and age were controlled for in all models. β= standardized regression coefficient or “beta weight.” R2 = percent of the variance in the dependent variable accounted for in the regression model. N = 1071.

*

p < .05.

**

p < .01,

***

p < .001.

The two-way interaction of spirituality and religiosity was significantly associated with all outcome variables. Figures 2a – 2d displays graphical representations of the interaction term for depressive symptoms, rejection sensitivity, resilience, and social support. As shown in Figure 2a, GBM who endorsed high levels of religiosity and spirituality reported experiencing significantly less depressive symptoms than GBM who endorsed high religiosity but low spirituality (M = 14.68 vs M = 27.31). Figure 2b showed a similar pattern in that GBM who endorsed high levels of religiosity and spirituality reported significantly lower levels of rejection sensitivity compared those who endorsed high religiosity but low spirituality (M = 12.37 vs M = 15.37). When examining the associations of the interaction of spirituality and religiosity with positive mental health outcomes, Figures 2c and 2d depict that GBM who endorsed high levels of religiosity and spirituality reported significantly higher levels of resilience (M = 39.70 vs M = 31.85) and social support (M = 78.13 vs M = 64.74) compared to GBM who endorsed high religiosity but low spirituality.

Figure 2.

Figure 2

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Figure 2a. Interaction effect of spirituality and religiosity showing that depressive symptom scores are lowest when both spirituality and religiosity are high.

Figure 2b. Interaction effect of spirituality and religiosity showing that rejection sensitivity scores are lower when spirituality is high across both high and low religiosity scores.

Figure 2c. Interaction effect of spirituality and religiosity showing that resilience scores are higher when spirituality is high across both high and low religiosity scores.

Figure 2d. Interaction effect of spirituality and religiosity showing that perceived social support scores are higher when spirituality is high across both high and low religiosity scores.

Discussion

This study analyzed the associations between spirituality and multiple dimensions of religion, as distinct and overlapping factors, with both positive and negative mental health outcomes in a U.S. national sample of HIV-negative GBM. As hypothesized, spirituality was inversely related to negative mental health outcomes and positively associated with positive mental health outcomes. Although spirituality has been defined in multiple ways (Miller & Thoresen, 2003), researchers have found that LGBT people emphasize the interpersonal aspects of spirituality that connect them with the sacred—or higher power(s) or something(s) divine outside of the self—and other people in ways that allow them to live morally, gain insight, and develop wisdom (Halkitis et al., 2009). Given this emphasis, it is not surprising that among GBM in this sample, spirituality was consistently associated with positive mental health outcomes and lower levels of negative mental health outcomes. If spirituality functions as an impetus for feelings of connectedness, regulation and guidance of lifestyle behaviors, and insight into self, others, and the world, it makes sense that the men in this sample would feel better about themselves (e.g., be less depressed), be less concerned about others rejecting or judging them, feel more connected with others, and be able to work through challenges more effectively.

Hypotheses about the associations between religiosity and mental health outcomes were generally confirmed. As hypothesized, religiosity was positively associated with rejection sensitivity and negatively associated with resilience. Many GBM have reported experiencing homonegativity in religious settings and from religious people (Barton, 2010; Griffin, 2006). These negative characteristics of religion contribute it to acting as a stressor for GBM instead of a protective factor. The results confirm this possible detrimental function of religiosity—the behavioral and participatory component of religion—in the lives of GBM. Homonegative experiences associated with religiosity may negatively influence GBM’s mental health. Many GBM report feeling rejection due to their same-sex attractions from their religious organizations, explicitly by fellow congregants and sometimes implicitly by the sacred, and from their parents for religious reasons (Griffin, 2006). This rejection may exacerbate anxious attachment styles and contribute to GBM being overly sensitive to future rejection (Landolt, Bartholomew, Saffrey, Oram, & Perlman, 2004) and engaging in detrimental health behaviors inconsistent with resilience (Bradshaw, Ellison, & Marcum, 2010; Horton, Ellison, Loukas, Downey, & Barrett, 2012). Contrary to predictions, religiosity was not independently associated with depressive symptoms or social support. This lack of association may be related to the overlapping qualities of spirituality with religiosity. Specifically, the unique and shared characteristics of spirituality (with religiosity) may be stronger correlates of depressive symptoms and perceived social support than the distinct characteristics of religiosity alone.

Religious coping was associated with higher levels of depressive symptoms and rejection sensitivity as well as lower levels of resilience and social support. These findings are consistent with other studies that have found that passive religious coping can lead to pathological outcomes (Barber & Gold, 2012; Newman & Pargament, 1990; Pargament et al., 1988). Although this study measured religious coping in general, many of the questions assessed what could be considered passive aspects of the construct and did not specifically tap into the active approach to religious coping such as partnering with the sacred or looking to the sacred for support. Furthermore, given many religions’ homonegative stance toward same-sex attractions, GBM may interpret their life difficulties to be punishment from God and perceive themselves as being unable to change them. Forms of religious coping (e.g., prayer and seeking help from the sacred) may become about redemption from sin rather than problem-solving and empowerment. With this perspective, religious coping functions as a tool of distress instead of relief. Therefore, it is not surprising that religious coping would have a negative association with the mental health outcomes in this sample.

When interpreting the interaction terms, it seemed that GBM experienced lower levels of negative mental health and higher levels of positive mental health when both spirituality and religiosity were high. Overall, these findings partly confirmed our hypotheses. Given that we expected religion and religious coping to act as minority stressors, due to their homonegative aspects, we did not anticipate that men with high levels of both religiosity and spirituality would have better mental health outcomes than men with low religiosity and high spirituality. Our findings indicate that religiosity may actually be salubrious for mental health as long as it is coupled with a high level of spirituality that provides meaning making and a sense of peace. Furthermore, spirituality may be related to a buffering effect that lowers the level of negative mental health outcomes that GBM experience when they only engage in religiosity.

This study has important implications for health research with GBM. It provides new insights into how functional aspects of spirituality and behavioral components of multiple dimensions of religion relate to the mental health of GBM. The functionality of spirituality is more influential and salubrious on GBM’s mental health than simply engaging in religious behaviors. Engaging in religious behaviors without the meaning, connectedness, and intrinsic morality that was associated with spirituality seemed to be a detriment to mental well-being. The findings highlight the importance of using multiple measures of religion and spirituality that tap into the various dimensions of these phenomena. Narrowly focusing on behavior may cause researchers to miss the complex ways in which religion and spirituality interact in the lives of GBM. A better understanding of the mechanisms through which spirituality may be able to buffer against religiosity’s negative mental health associations is critical. It may be that highly spiritual individuals are able to use their personal relationships with the sacred and intrinsic spirituality to help them selectively reject non-affirming aspects of their religious tradition that attempt to condemn them. Qualitative studies have found that some GBM are able to use strategies such as personal interpretation of religious text and questioning the knowledge-level of people who use religion to justify their homonegative prejudice (Lassiter, 2015; Pitt, 2010). Such strategies allow some GBM to maintain a sense of spirituality in the face of antigay religious messaging. Research that aims to understand if similar processes may explain the potential buffering role of spirituality in the presence of religiosity is critical to gaining more nuanced knowledge about how religion and spirituality operates in the lives of GBM.

Public health interventions and clinical practice aimed at decreasing negative mental health outcomes among GBM could be enhanced by the current study’s findings. Integration of religion and spirituality in mental health interventions may include discussing how GBM understand the connections of religion, spirituality, and health in their lives. It may also include helping GBM enhance spirituality and meaning-making in their lives so that they may better understand and positively reframe struggles (e.g., homonegativity, discrimination, poverty, racism) as opportunities for spiritual growth and action. Mental health interventionists are encouraged to integrate programming that aids religiously-oriented GBM in developing higher levels of spirituality and active religious coping. If GBM are able to engage in active religious coping that is void of homonegativity and focuses on using their spirituality, it may empower them to make healthy lifestyle choices and better cope with health problems. Furthermore, mental health providers may find it appropriate and beneficial to facilitate their patients in reconciling their religious and sexual identities (Lassiter, 2015) and reengaging with homoaffirming religious and spiritual resources (Bozard & Sanders, 2011). The overall goal is to maximize the benefits of religion and spirituality and minimize their negative impact so as to promote positive mental health among GBM (Lassiter, 2014).

We have interpreted and discussed the scholarly and clinical implications of our findings but they are not without limitations. Although this sample does closely mirror the demographic characteristics of the U.S. as well as the distribution of GBM across the U.S., this sample was composed of predominately White GBM. Given the inclusion criterion that all men be HIV-negative, many men of color initially screened via CMI were found to be ineligible given their HIV-positive serostatus. Therefore, these findings should be interpreted with caution when applying them to GBM of color and may not be applicable to HIV-positive GBM. We used measures that assessed the functional aspects of spirituality and the behavioral components of religiosity and religious coping, we would have benefited by having measures that assessed the functional and behavioral characteristics of both spirituality and religion. Measures that assess both components of both constructs could add more insight into the particular mechanisms of their interactions with health. However, to the authors’ knowledge no such measures with those characteristics exist. Finally, this study was web-based and the sample was recruited through our partnership with CMI who engaged people who were already familiar with web-based study procedures. GBM who did not know how to use a computer or who did not have Internet access were not eligible to be a CMI panelist and thus are not represented in the current study.

This study represents a significant contribution to the psychological literature concerning religion, spirituality, and the mental health of GBM. These findings provided new insights into the ways in which spirituality and multiple dimensions of religion are associated with both positive and negative mental health outcomes for GBM. Spirituality was consistently associated with positive mental health outcomes and lower levels of negative ones. Contrarily, religiosity—solely expressed through behaviors and devoid of spirituality—was associated with negative mental health outcomes. Public health interventionists and mental health providers are encouraged to incorporate spirituality and religion in their work with religiously and spiritually-oriented GBM to help these men minimize the negative aspects of these forces and maximize their salubrious agents to promote positive mental health.

Acknowledgments

The One Thousand Strong study was funded by NIH/NIDA (R01 DA 036466: Jeffrey T. Parsons & Christian Grov). Jonathan Lassiter’s effort was supported by a supplement to the parent grant. We would like to acknowledge other members of the One Thousand Strong Study Team (Dr. Jonathon Rendina, Mark Pawson, Michael Castro, Ruben Jimenez, Brett Millar, Chloe Mirzayi, Raymond Moody, Anita Viswanath, and Thomas Whitfield) and other staff from the Center for HIV/AIDS Educational Studies and Training (Qurrat-Ul Ain, Andrew Cortopassi, Chris Hietikko, Doug Keeler, Chris Murphy, Carlos Ponton, and Brian Salfas). We would also like to thank the staff at Community Marketing Inc (David Paisley, Thomas Roth, and Heather Torch) and Dr. Patrick Sullivan, Jessica Ingersoll, Deborah Abdul-Ali, and Doris Igwe at the Emory Center for AIDS Research (P30 AI050409). Finally, special thanks to Drs. Jeffrey Schulden and Pamela Goodlow at NIDA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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