Brief Report
The Gerontologist
Vol. 48, No. 5, 692–697
Copyright 2008 by The Gerontological Society of America
Rebecca S. Allen, PhD,1,2 Laura Lee Phillips, PhD,1,2 Lucinda Lee Roff, PhD,2,3
Ronald Cavanaugh, PsyD,4 and Laura Day, MA4
Purpose: With the rapid growth in the older inmate
population, emerging issues regarding physical and
mental health require greater research and clinical
attention. We examined the relation of religiousness/
spirituality; demographic characteristics such as age,
race, and type of crime; and physical and mental
health among 73 older male inmates in the state of
Alabama. Design and Methods: Inmates older than
age 50 who passed a cognitive screening completed
face-to-face interviews lasting between 30 and 60
min. Due to the low literacy rates of the participants,
we administered all measures orally with response
cards to facilitate understanding. Results: Nearly
70% of the inmates were incarcerated for murder or
sexual crimes. There were no racial/ethnic differences in reported religiousness/spirituality, demographic characteristics, or mental health. We
found an association between self-reported years of
incarceration and experienced forgiveness. Three
regression models examined whether inmates’ selfPortions of this paper were presented at the 58th Annual Scientific
Meeting of The Gerontological Society of America, Orlando, FL,
November 2005. This research was supported by funding from the
Center for Mental Health and Aging, The University of Alabama, to
Rebecca Sue Allen. Special thanks are extended to Michelle M. Hilgeman
for assistance with data collection and to all of the inmates, correctional
officers, and staff at the Alabama Aged and Infirmed Correctional
Facility who gave their time and energy to this project.
Address correspondence to Rebecca S. Allen, PhD, 348 Gordon
Palmer Hall, Hackberry Lane, University of Alabama, Tuscaloosa, AL
35487-0348. E-mail: rsallen@ua.edu
1
Department of Psychology, The University of Alabama, Tuscaloosa.
2
Center for Mental Health and Aging, The University of Alabama,
Tuscaloosa.
3
School of Social Work, The University of Alabama, Tuscaloosa.
4
Department of Corrections, Alabama Aged and Infirmed Correctional Facility, Hamilton.
692
reported religiousness/spirituality influenced anxiety,
depression, and desire for hastened death. We
found that having a greater number of daily
spiritual experiences and not feeling abandoned
by God were associated with better emotional
health. Implications: Future studies, perhaps using
longitudinal or case-control methodology, should
examine whether increased daily spiritual experiences and decreased feelings of abandonment by
God foster better mental health among older inmates.
Key Words: Older inmates, Religiousness/spirituality,
Depression, Anxiety, Hastened death
Older inmates are the fastest growing segment of
the population in U.S. federal and state prisons
(Williams, 2006). Aday (2003) reported that the
number of prisoners 50 years and older in state and
federal correctional facilities in 2001 was 113,358,
3 times as many as the number in 1990. This growth
results from the overall aging of the population,
tougher sentencing laws (e.g., mandatory minimums
and ‘‘three strikes’’ laws), and the elimination of
parole programs (Yates & Gillespie, 2000). Older
inmates’ physical health and mental health care
needs are stretching already scarce resources allocated for prison programming (Fazel, Hope,
O’Donnell, & Jacoby, 2004; Mitka, 2004; Morton,
1992; Regan, Alderson, & Regan, 2002). The annual
cost of incarceration for an older inmate exceeds
$60,000 annually and is approximately 3 times that
of their younger counterparts (U.S. Department of
Justice, 2000). There is some evidence that religiousThe Gerontologist
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Religiousness/Spirituality and Mental Health
Among Older Male Inmates
inmates or other underserved populations (e.g.,
Crowther, Parker, Achenbaum, Larimore, & Koenig,
2002), and the measurement of these constructs
may operate somewhat differently with inmates than
with community-dwelling adults.
Mental Health and the Older Prisoner
Religiousness/Spirituality in the Prison Setting
Nearly 40% of state inmates 55 and older have a
recent history or symptoms of mental health disorders (James & Glaze, 2006). Researchers have
documented significant mental health problems
among older inmates in U.S. prisons (Colsher,
Wallace, Loeffelholz, & Sales, 1992; Loeb &
AbuDagga, 2006; Regan et al., 2002) and among
those of other nations (Fazel & Grann, 2002, 2004;
Fazel & Lubbe, 2005). Aday (2003) reviewed several
U.S. studies of older inmates and noted that depression, guilt, worry, and psychological stress are
common. Inmates also highlighted the stress of being
away from their families, the stigma associated with
their crime, and depression related to the possibility
of dying in prison as some of the largest factors in
their problems with emotional well-being.
Only one study has examined religiousness and
mental health among incarcerated older male
inmates at a federal correctional facility (Koenig,
1995). This study examined associations between
depression and a number of religious domains. A
total of 37% of inmates had a history of psychiatric
problems requiring treatment. Of these, 57% were
incarcerated for drug charges, 9% for robbery or
embezzlement, and the remaining 34% for unspecified crimes. Approximately one third of the sample
claimed that religion was their most important
coping method. Lower levels of depression were
significantly associated with greater attendance at
religious services and higher levels of intrinsic
religiousness, but there was no relationship between
private religious activities and depression.
Religiousness/Spirituality and Mental Health
Need for the Current Study
A growing literature links religious participation
with better mental health among older adults (Chen,
Cheal, Herr, Zubritsky, & Levkoff, 2007; Hackney &
Sanders, 2003; Hebert, Dang, & Schulz, 2007;
Klemmack et al., 2007; Koenig, 1998; Koenig,
McCullough, & Larson, 2001; Levin & Chatters,
1998a). Ellison (1994) provided a conceptual framework to help understand the mechanisms through
which religious involvement and spirituality may influence mental health. He suggested that religiousness/
spirituality may (a) reduce the risk of a number
of stressors (e.g., antisocial behavior); (b) provide a
sense of meaning or coherence that counteracts stress
and assists with coping; and (c) provide a network
of like-minded persons who can serve as social
resources and promote the development of psychological resources, including self-esteem and a sense
of personal worth.
Efforts to assess the impact of religiousness/spirituality on mental health have suffered from difficulties in measuring religiousness (Levin & Chatters,
1998b). Researchers have recognized that the concepts of religiousness and spirituality are complex
and multidimensional. In response, the Fetzer Institute and the National Institute on Aging convened
a panel of scholars to devise a series of short measures representing the domains of religiousness/
spirituality most likely to influence mental health
(Fetzer Institute/National Institute on Aging Work
Group [Fetzer/NIA], 1999; Idler et al., 2003). A
number of these measures may be particularly salient
in studies of religiousness/spirituality involving
The purpose of this study was to understand the
relations between dimensions of religiousness/spirituality and anxiety, depression, and desire for
hastened death within a sample of older male state
inmates. Koenig (1995) examined depression among
federal inmates, and Aday’s (2003) research with
older state prisoners supported the notion of increased anxiety and, perhaps, desire for hastened
death among these individuals. The dimensions of
religiousness/spirituality we chose to examine were
daily spiritual experiences, forgiveness, positive religious coping, feelings of abandonment (e.g., a measure of negative religious coping), private religious
practices, and religious meaning. In relation to
Ellison’s (1994) model, positive religious coping
and private religious practices may reduce stressors,
and daily spiritual experiences and religious meaning
may provide a sense of meaning or coherence that
assists with coping. The experience of forgiveness
and feelings of abandonment by God have particular
salience in the prison setting, and we explored them
in relation to anxiety, depression, and desire for
hastened death.
Three issues contrast our work with Koenig’s
(1995). First, Koenig’s study was conducted in the
federal prison system. State prisons can vary dramatically from one another and from the federal system
in terms of available resources. State prisoners may
differ from federal prisoners in criminal history.
Second, the men in our study were 6 years older, on
average, than those in Koenig’s study. Third, besides
depression, we examined anxiety and desire for
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693
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ness helps inmates cope with the prison experience
(Clear & Sumter, 2002). Only one study, however,
examined the relationship between religiousness/
spirituality and mental health in the older prisoner
(Koenig, 1995).
hastened death as well as additional components of
religiousness/spirituality.
Research Design and Hypotheses
Methods
Participants
All inmates older than age 50 (N = 81) at the
Alabama Aged and Infirmed Correctional Facility in
Hamilton, Alabama, were invited to participate in
a screening for eligibility for this study. Although 50
is not considered old in community settings, inmates’
physical health may resemble that of people approximately 10 years older than the inmates’ chronological age (Dawes, 2002). This difference may be due to
inmates’ history of excessive drug and alcohol use,
poor nutrition, stressful life experiences, personal
neglect, and lower socioeconomic status in comparison with nonoffenders.
Screening with the Mini-Mental State Examination (Folstein, Folstein, & McHugh, 1975) and the
reading subtest of the Wide Range Achievement
Test (Wilkinson, 1993) determined functional level of
educational achievement and whether the inmate was
cognitively able to participate in the study (Manly,
Byrd, Touradji, & Stern, 2004). A total of 76 older
inmates agreed to participate (94%). We deemed 3
inmates to be ineligible due to scoring below 15 on
the Mini-Mental State Examination (Newman,
2003). Participants who passed the screening completed face-to-face interviews lasting from 30 to
60 min. We administered all measures orally with
response cards to facilitate understanding.
Measures
Brief Multidimensional Measure of Religiousness
and Spirituality (Fetzer/NIA, 1999).—This study
used six indices or items from the Brief Multidimensional Measure of Religiousness and Spirituality (19
Likert-type items) with the following psychometric
properties in this sample.
The Daily Spiritual Experiences index (six items;
range = 6–36; a = .87) was intended to measure ‘‘the
694
Demographics.—Participants provided their age,
race, marital status, years of education, self-rating of
general health, type of crime, and self-reported years
of incarceration for the current offense.
Brief Symptom Inventory–Third Edition (Derogatis,
1993).—We chose the Depression (five items; a =
.80; range = 0–20) and Anxiety (six items; a = .78;
range = 0–24) subscales of the Brief Symptom
Inventory for brevity and due to the desire to measure anxiety in addition to depression. These Brief
Symptom Inventory subscales have test–retest reliability ranging from r = .68–.84. Construct validity
estimates are high, with factor loadings ranging from
.42 to .65 for Depression and .49 to .57 for Anxiety.
Hastened Death Scale–Modified (Rosenfeld et al.,
1999).—The Hastened Death Scale–Modified is a
20-item scale written for assessing patients with a
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We used regression analyses to explore the
relation of participant characteristics and selected
measures of religiousness/spirituality derived from
Ellison’s (1994) model or suggested by Aday’s (2003)
findings on depression, anxiety, and desire for
hastened death. We hypothesized that an inverse
relationship would exist between measures of positive religiousness/spirituality and anxiety, depression, and desire for hastened death. However, we
anticipated that the measure of negative spiritual
coping (e.g., feelings of abandonment by God) would
be associated with higher levels of anxiety, depression, and desire for hastened death.
individual’s perception of the transcendent (God, the
divine) in daily life and the perception of interaction
with, or involvement of, the transcendent in life’’
(Fetzer/NIA, 1999, p. 11). Illustrative items asked
participants how often they ‘‘find strength and comfort in my religion,’’ ‘‘feel God’s love for me, directly
or through others,’’ and ‘‘feel God’s presence.’’
Items in the Forgiveness index (three items;
range = 3–12; a = .75) asked participants how
often they had ‘‘forgiven myself for things that I have
done wrong,’’ ‘‘have forgiven those who hurt me,’’
and ‘‘know that God forgives me.’’
The Positive Religious Coping index (four items;
range = 4–16; a = .82) addressed ‘‘benevolent religious methods of understanding and dealing with life
stressors’’ (Fetzer/NIA, 1999, p. 43) and included
items such as ‘‘I work together with God as partners
to get through hard times’’ and ‘‘I look to God
for strength, support and guidance in crises.’’ The
one item used from the Negative Religious Coping
index dealing with religious struggle in coping
was ‘‘I wonder whether God has abandoned me’’
(range = 1–4).
The Private Religious Practices index (three items;
range = 3–24; a = .79) measures religious involvement that is nonorganizational and informal. Items
asked participants to indicate how often they prayed
privately in places other than at church or synagogue, how often they read the Bible or other religious literature, and how often they said prayers or
grace before or after meals.
Two items suggested for consideration as a shortform measure of ‘‘religious meaning’’ (Fetzer/NIA,
1999) were ‘‘I believe in a God who watches over
me’’ and ‘‘I feel a deep sense of responsibility for
reducing pain and suffering in the world’’ (two
items; range = 2–8; a = .64). These items assessed an
individual’s sense of having a ‘‘unique, externally
given purpose in life’’ (Fetzer/NIA, 1999, p. 19).
Table 1. Demographic Characteristics of
Participants (N = 73)
Characteristic
Frequency
Percentage
28
23
22
38.4
31.5
30.2
Type of crime
Murder
Sexual crime
Othera
SD
63.68 8.96
26.07 3.86
87.25 18.74
11.55 10.29
11.11 3.90
2.03 1.17
1.27 1.67
4.01 4.16
3.66 4.18
12.72
3.62
10.58
3.11
0.89
2.01
27.70
6.03
6.63
1.50
6.21
1.86
Notes: Possible ranges: MMSE, 1–30; WRAT, 45–122; Selfrated health, 1–5; Hastened death, 0–10; Depression, 0–20;
Anxiety, 0–24; Positive Religious Coping, 4–16; Abandoned by
God, 1–4; Forgiveness, 3–12; Daily Spiritual Experiences, 6–36;
Religious meaning, 2–8; Private Religious Practices, 3–24.
MMSE = Mini-Mental State Examination; WRAT = WideRange Achievement Test.
a
The majority of other crimes were assault or for financial
gain. However, one prisoner refused to state why he was sentenced to life, and one prisoner stated he solicited another
individual to commit murder.
terminal illness (range = 0–20). We selected 10 items
that could be easily altered by replacing ‘‘cancer’’ or
‘‘illness’’ with ‘‘in prison’’ so that the instrument
would measure the influence being in prison has
upon desire for hastened death (range = 0–10; a =
.71). Exemplar items include ‘‘Being in prison has
drained me so much that I do not want to go on
living,’’ ‘‘Unless I am able to reduce my sentence or
get out of prison, I will consider taking steps to end
my life,’’ and ‘‘I hope my health will fail rapidly
because I would prefer to die rather than continue
living in prison.’’
Procedure
Two interviewers received standardized instruction in interview technique and the administration of
study measures by a licensed clinical psychologist
(Rebecca S. Allen). Interviewers were trained to
criterion and passed a ‘‘check-out’’ with the licensed
psychologist prior to data collection. Inmates older
than age 50 were escorted to the semiprivate
interview area by a correctional officer, who stood
50 feet away from the interview area to allow
Vol. 48, No. 5, 2008
695
Data Analysis
Table 1 reports descriptive statistics for each
variable. We conducted three linear regressions using
age and self-reported health as control variables and
all religiousness/spirituality measures for each of our
dependent variables (e.g., anxiety, depression, and
desire for hastened death). We were interested in
examining relations with anxiety, depression, and
desire for hastened death separately, as relations
between religiousness/spirituality and two of these
constructs have not been examined previously
among older male inmates. Our regression models
included no interaction terms due to our small
sample size and resultant limitations in power to
detect significant interaction effects. We centered the
individual multi-item subscales of the Brief Multidimensional Measure of Religiousness and Spirituality,
allowing for easy interpretation of the beta weights.
Results
Description of Participants
Of the participants, 67% were Caucasian (n = 49)
and 33% African American (n = 21) or Native
American (n = 3). The majority of participants had
committed either murder (n = 28, 38%) or a sexual
offense (n = 23, 32%). Concerning religious
affiliation, 60% of participants reported being
Baptist, 11% Church of God, and 25% ‘‘other.’’
Only 4% reported that they had no religious/
spiritual affiliation. In addition, 68% reported not
having taken medication for ‘‘mood or nerves.’’
There were no significant differences between
Caucasians and minorities in current age, number
of years of education, religiousness/spirituality,
anxiety, depression, or desire for hastened death.
Bivariate Correlations
Self-reported years of incarceration was associated
with the type of crime committed (r = .25, p = .033).
Participants incarcerated for murder or assault
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Continuous variables
Age
MMSE
WRAT
Years incarcerated
Years of education
Self-rated health
Hastened death
Depression
Anxiety
Positive Religious
Coping
Abandoned by God
Forgiveness
Daily Spiritual
Experiences
Religious meaning
Private Religious
Practices
M
privacy. Inmates were read informed consent forms
and received copies of brief, bulleted consent forms
highlighting the risks and benefits of participation.
After signing consent forms, the inmates were
administered the Mini-Mental State Examination
and Wide Range Achievement Test reading subtest
to determine their eligibility for participation.
Inmates deemed eligible to participate were read
each item in the assessment battery and were shown
response cards with the appropriate possible responses for each assessment (e.g., Likert-type response items, true/false items, as appropriate). At the
end of the interview, the inmate was thanked for his
time and was escorted back to the general population by the correctional officer.
Table 2. Regression Models for Anxiety, Depression, and Desire for Hastened Death
Anxiety
Variable
b
Age
Self rated health
Private Religious Practices
Positive Religious Coping
Feeling abandoned
Forgiveness
Daily Spiritual Experiences
Meaning
Adjusted R2
.016
.246
.091
.003
.135
.057
.154
.076
.04
t
0.12
1.85
0.53
0.01
1.06
0.33
0.77
0.45
Depression
p
t
b
.90
.07
.60
.99
.29
.75
.44
.65
.145
.249
.043
.470
.255
.198
.415
.210
.39**
1.45
2.34
0.31
2.71
2.50
1.43
2.62
1.56
Hastened Death
p
.15
.02*
.76
.01*
.01*
.16
.01*
.12
b
.130
.083
.145
.200
.470
.001
.231
.115
.31*
t
1.22
0.74
0.99
1.08
4.34
0.01
1.37
0.80
p
VIF
.23
.46
.33
.28
.001*
.99
.18
.42
1.10
1.23
2.07
3.28
1.13
2.09
2.75
1.98
reported more years of incarceration (Ms = 15.32
and 13.25, respectively) than did those incarcerated
for sexual (M = 10.65), financial (M = 8.86), drugrelated (M = 3.75), or other (M = 8.00) crimes.
Greater self-reported years of incarceration was also
associated with lower levels of forgiveness (r = .25,
p = .036). Type of crime was associated with
religious meaning (r = .28, p = .017) such that those
who committed other offenses reported more religious meaning than those who committed murder
or sexual crimes. Marital status was associated with
religious meaning (r = .26, p = .029) such that
individuals who were divorced or separated reported
less meaning than individuals who were married or
widowed.
Regression Analyses
Table 2 depicts the results of the regression
models. Based on the recommendation of Cohen,
Cohen, West, and Aiken (2003), none of the models
showed significant multicollinearity among the
variables. The overall model for anxiety was not
significant, F(8, 67) = 1.34, p = .242, R2 = .15,
adjusted R2 = .04. However, the overall model for
depression was significant, F(8, 67) = 6.27, p ,
.0001, R2 = .46, adjusted R2 = .39. Inmates who
reported better health and those who reported
feeling less abandoned by God and having more
daily spiritual experiences reported fewer symptoms
of depression. Of note, those reporting less positive
religious coping also reported fewer symptoms of
depression. The overall model for desire for hastened
death also was significant, F(8, 67) = 4.71, p ,
.0001, R2 = .39, adjusted R2 = .31. Inmates who
reported feeling less abandoned by God reported less
desire for hastened death.
Discussion
This study extends prior research regarding
religiousness/spirituality and mental health among
696
older male inmates in three ways: (a) Participants
were incarcerated primarily for murder and sexual
crimes; (b) participants were 6 years older, on
average, than those in prior research (Koenig,
1995); and (c) anxiety and desire for hastened death
were examined in addition to depression. As
expected, we found that better self-reported health
was associated with less anxiety and depression
among older male inmates. It is interesting that
forgiveness, private religious practices, and religious
meaning did not explain unique variance in anxiety,
depression, or desire for hastened death. As Ellison’s
(1994) model would predict, having greater daily
spiritual experiences was associated with less depression and less desire for hastened death. However,
other measures of religiousness/spirituality displayed
positive associations with negative mental states.
Specifically, positive religious coping was associated
with increased feelings of depression. It may be that
depressed inmates attempt to cope with their
negative emotional state by turning to God. Moreover, feeling abandoned by God was associated with
more symptoms of depression and a greater desire
for hastened death. Thus, it appears that the relation
between religiousness/spirituality and mental health
among older male inmates depends largely on
whether individuals feel connected with or abandoned by a Higher Power. The implications of these
findings require further study, possibly using qualitative methods, in order to examine the potential
conflict between the belief that death will bring
a relief from confinement and suffering and the oftheld religious belief that death will bring one into
God’s presence.
Additionally, we found that more self-reported
years of incarceration was associated with lower
levels of experienced forgiveness. Although there was
no significant bivariate association between type of
crime and forgiveness, inmates who were incarcerated for murder or assault reported more years of incarceration. These violent crimes may be associated
with greater societal stigma or remorse.
The Gerontologist
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Notes: Multicollinearity among variables was not significant based on the variance inflation factor (VIF), as only those above
10 are considered to demonstrate significant multicollinearity (Cohen, Cohen, West, & Aiken, 2003).
*p , .05; **p , .01.
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Received August 7, 2007
Accepted September 25, 2007
Decision Editor: William J. McAuley, PhD
Downloaded from http://gerontologist.oxfordjournals.org/ at Pennsylvania State University on May 10, 2016
Limitations of this study include the single study
site, the small number of participants, and the fact
that some of the measures were relatively new (e.g.,
religious meaning, desire for hastened death in
prison) and required further examination of psychometric properties and construct validity. However,
the 73 participants in this study were similar to older
first offenders in type of crime (Aday, 2003, p. 33), as
these individuals tend to be incarcerated for crimes
such as rape, murder, and child molestation. Moreover, the measures used in this study exhibited
adequate to good internal consistency in this sample.
Nevertheless, certain aspects of this sample may have
been unique (e.g., 60% Baptist), and these results need
to be replicated in a representative national sample.
The increase in the number of older inmates in the
past decade necessitates innovative and cost-effective
approaches to physical and mental health care in
cash-strapped systems. Exploring the relation of
positive and negative aspects of religiousness/spirituality and mental health holds clinical and scientific
promise for improving quality of life and further
developing conceptual models such as Ellison’s (1994).
Future research should use longitudinal or casecontrol methods in nationally representative samples
to further examine the relation between mental health
among older inmates and increased daily spiritual
experiences or decreased feelings of abandonment by
God. Perhaps those inmates who experience increased
daily spiritual experiences might feel less abandoned
and, thus, have better mental health.