PLOS ONE

RESEARCH ARTICLE

Medicine for the soul: (Non)religious identity,

coping, and mental health during the
COVID-19 pandemic
Claire Peneycad ID1, Renate Ysseldyk ID1*, Emily Tippins ID1, Hymie Anisman2

1 Department of Health Sciences, Carleton University, Ottawa, Canada, 2 Department of Neuroscience,

Carleton University, Ottawa, Canada

a1111111111 * [email protected]
a1111111111
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a1111111111 Abstract
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Although the threat and uncertainty of the COVID-19 pandemic has become a significant
source of distress, using religion to cope may be associated with more positive health.
Given the severity and chronicity of the pandemic, religious individuals may also have relied
OPEN ACCESS on a variety of non-religious coping methods. Much of the existing COVID-19 research over-
Citation: Peneycad C, Ysseldyk R, Tippins E, looks the role of religious group membership and beliefs in relation to coping responses and
Anisman H (2024) Medicine for the soul: (Non) associated mental health, with an additional lack of such research within the Canadian con-
religious identity, coping, and mental health during text. Thus, this cross-sectional study investigated relations among religiosity, stressor
the COVID-19 pandemic. PLoS ONE 19(1):
appraisals, (both religious and non-religious) coping strategies, mental and physical health
e0296436. https://doi.org/10.1371/journal.
pone.0296436 in a religiously-diverse Canadian community sample (N = 280) during the pandemic’s 2nd
wave from March to June 2021. Numerous differences were apparent in appraisal-coping
Editor: Ching Sin Siau, University Kebangsaan
Malaysia, MALAYSIA methods and health across five (non)religious groups (i.e., Atheists, Agnostics, “Spiritual but
not religious”, Christians, and those considered to be religious “Minorities” in Canada). Reli-
Received: May 18, 2023
giosity was also associated with better mental health, appraisals of the pandemic as a chal-
Accepted: December 13, 2023
lenge from which one might learn or grow, and a greater reliance on problem-focused,
Published: January 2, 2024 emotional-engagement, and religious coping. Moreover, both problem-focused and emo-
Copyright: © 2024 Peneycad et al. This is an open tional-engagement coping mediated the relations between religiosity and health. Taken
access article distributed under the terms of the together, this research has implications for individual-level coping as well as informing cul-
Creative Commons Attribution License, which
turally-sensitive public health messages promoting targeted self-care recommendations
permits unrestricted use, distribution, and
reproduction in any medium, provided the original with integrated religious or spiritual elements during times of threat and uncertainty, such as
author and source are credited. the COVID-19 pandemic.
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files.

Funding: This work was funded in part by the

Carleton University Department of Health Sciences Introduction
(RY). https://carleton.ca/healthsciences/ This
funder did not play a role in study design, data Since the onset of the COVID-19 pandemic in March 2020, the SARS-CoV-2 virus has had
collection and analysis, decision to publish, or lasting impacts. COVID-19 has taken a toll on the physical health of individuals around the
preparation of the manuscript. world, while governments and health care systems have been overwhelmed, and almost 7 mil-
Competing interests: The authors have declared lion people had died as of October, 2023 [1]. In addition to the physical health disturbances
that no competing interests exist. posed by COVID-19, the pandemic resulted in harmful repercussions to mental health [2].

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PLOS ONE Medicine for the soul

The health and fatality risks of COVID-19, heightened distress related to risk of infection, as
well as isolation due to government-imposed social distancing and lockdown measures have
resulted in poor mental health outcomes with lasting impacts world-wide [2–4].
The pandemic evoked a wide range of coping methods to deal with the ongoing threat [5,
6]. As with responses to a variety of stressors, some of these coping strategies have been more
adaptive (e.g., support-seeking, problem-solving) than have others (e.g., drug and alcohol use,
rumination) [7]. Moreover, the use of diverse stressor appraisal and coping strategies may vary
depending on an array of socio-demographic factors, group memberships, and identities [8–
10]. In the context of the present investigation, stressor appraisals refer to an individual’s eval-
uation of a stressful event, whereas coping strategies refer to an individual’s cognitions or
behaviours used to manage the stress [11]. This study investigated associations among self-
reported religious beliefs and identities, stressor appraisals, coping strategies, as well as mental
and physical health during the COVID-19 pandemic in a diverse community sample of partic-
ipants across Canada. In view of the effectiveness of religiosity as a coping strategy among
some individuals [12–15], it was anticipated that those who identified with a religious group
(compared to those who did not) would self-report more adaptive stressor appraisals, coping,
and health outcomes. Given associations among various appraisals and coping strategies with
health [16–18], it was also expected that appraisal-coping processes would mediate the rela-
tions between religiosity and self-reported health.

COVID-19 and mental health

The COVID-19 health threat has become a significant and chronic source of distress associ-
ated with increased mental health symptoms, including depression and anxiety. A nationally-
representative study of Canadians revealed that symptoms of anxiety were reported to be four
times higher during—compared to before—the COVID-19 pandemic, and reports of depres-
sive symptoms nearly doubled [2]. Similarly, distress levels among Americans early in the
COVID-19 pandemic were notably high, as were symptoms of depression and anxiety [3].
Individuals considered to be at higher risk of severe COVID-19 infections, including older
adults and those with underlying medical issues, were found to be at an even greater risk of
experiencing anxiety symptoms [19]. Comparable outcomes had similarly been reported dur-
ing the SARS epidemic from 2002–2004, where social disengagement, stress, and anxiety
resulted in higher rates of suicide deaths among older adults [20].
Many countries implemented lockdowns and restrictions of varying degrees in an attempt
to prevent further viral spread of COVID-19 and relieve overwhelmed health care systems.
These restrictions were helpful in reducing the number of COVID-19 cases and in protecting
physical health [21], but lockdowns may have also contributed to poor mental health out-
comes. Indeed, the traumatic stress responses of quarantined or isolated parents and children
during an earlier pandemic revealed that 25% of parents and 30% of children met the criteria
for post-traumatic stress disorder (PTSD) [22]. More recent studies likewise indicated elevated
psychological distress in populations that experienced COVID-19-related quarantine mea-
sures, including increased prevalence of panic disorder, anxiety, and depression [4]. As
COVID-19 continues to affect the lives of people around the world, along with the potential
for similar events occurring in the future, it is imperative that the mental health implications
of such scenarios are better understood so that prophylactic measures can be supported when
the next pandemic emerges.

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Religion, coping, and mental health

Considerable research has indicated that relying on religion to cope with stress is often associ-
ated with more positive mental health outcomes [12, 14, 15, 23–26]. Indeed, various functions
of religion might provide possible explanations for improved mental health, such as providing
meaning in life, strong community networks and social support, and having ideologies that
promote healthy lifestyle behaviours [27]. For example, the association between greater belief
in God and having a greater sense of meaning in life has been associated with reduced levels of
depression [28]. In addition, having a greater sense of meaning in life may also offer hope to
individuals experiencing adversity and may thereby facilitate coping with stressful events and
traumatic experiences [29]. From a social perspective, the importance of community—and
associated collective group identity—inherent to many religions can also provide individuals
with strong social support networks when faced with stressful situations [30–34]. Finally,
many religions promote healthy practices and thought processes as part of their ideologies that
often increase self-control [35], mindfulness, and gratitude, each of which have been linked to
increased positive mental health outcomes [25, 36].
Beyond these positive lifestyle choices and ideologies, the strong influence of religious beliefs
and spirituality on coping strategies—including an array of non-religious strategies—have been
associated with mental health outcomes [37–41]. Specifically, such studies have provided evi-
dence that religious identity and beliefs are often linked to more adaptive stressor appraisals
and coping strategies. In the field of religion and coping, religious coping is considered as the
translation of common religious beliefs into specific ways to cope with stress [42, 43], notwith-
standing that religious coping itself can take both positive (e.g., prayer [44]) and negative (e.g.,
anger at God, [45]) forms with each shown to be habitually associated with either positive or
negative mental health outcomes, respectively [12, 15, 46, 47]. Whereas religious coping
requires previously established religious beliefs, the use of non-religious coping methods (e.g.,
rumination, social support seeking, humour) to cope with stressors may or may not be accom-
panied by such beliefs [42, 43]. As such, religious individuals also engage in a variety of apprais-
als and coping strategies that are not directly related to their religious beliefs or identity. For
example, religious individuals may be more likely to appraise stressful events as challenging
rather than threatening [48, 49]. Moreover, religious individuals may engage in both religious
and non-religious social support-seeking as an emotional-engagement coping strategy, as well
as endorse problem-focused coping strategies to cope with adverse events [33, 41].
Within the context of the COVID-19 pandemic, it has been reported that Google searches
using the word “prayer” reached a record high in March 2020, the timing of which corre-
sponds with the onset of the pandemic [50, 51]. Consistent with the notion that people often
rely on their religious beliefs to cope with traumatic events, interest in religion surged through-
out the course of the pandemic [50, 52]. However, many pandemic-related restriction mea-
sures, such as stay-at-home orders and indoor capacity limits, might have been a source of
distress for religious individuals in particular [26, 51, 53]. In particular, many religions value
routine religious social gatherings and worship services, and previous research suggests a posi-
tive association between religious service attendance and positive mental health [24, 26, 54].
Lockdowns and restrictions greatly limited these opportunities, possibly contributing to
poorer mental health outcomes among religious individuals [5, 54]. Indeed, in the absence of
regular contact with one’s religious group members during the pandemic, religious individuals
may have relied more heavily on a variety of non-religious appraisals and coping strategies.
However, to our knowledge, no research has examined the use of non-religious appraisal-cop-
ing processes among religious (compared to non-religious) individuals in the COVID-19 pan-
demic context.

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The present research

Although considerable research has been conducted on mental health outcomes associated
with various life stressors, there has been less focus on the role of religious group membership
and beliefs in relation to coping responses and associated mental health, specifically within the
context of COVID-19. Moreover, much of this research has been conducted in non-Canadian
contexts [3, 6, 13, 19, 23, 51], where social and political factors (including national pandemic
responses) may differentially affect outcomes. For example, the Canadian health care system
provides publicly-funded, universal access to medical services, whereas many other countries
do not (most notably the USA, where much of the existing research has been conducted). In
addition, such social and political factors, including political leadership, public opinion and
compliance, economic considerations, and vaccine rollout were unique to each country’s
response to the COVID-19 pandemic. This, in turn, affected the total number of COVID-19
cases, deaths, as well as vaccine doses administered. At the beginning of our data collection
(March 15th, 2021), there were approximately 900,000 cumulative confirmed COVID-19 cases
and 22,000 cumulative confirmed COVID-19 deaths in Canada, with 7% of the Canadian pop-
ulation having received at least one dose of the COVID-19 vaccine [55]. Thus, the present
study examined religious group identity and beliefs, stressor appraisals, (both religious and
non-religious) coping strategies, as well as mental and physical health in a multi-cultural Cana-
dian sample during the COVID-19 pandemic. Potential differences in appraisal-coping
responses, mental, and physical health were examined across a variety of (non)religious
groups. In addition, relations among religiosity, appraisals, coping, and health, as well as the
potential mediating roles of appraisal-coping processes in the links between religiosity and
health, were examined in this pandemic context.

Method
Participants and procedure
A total of 392 people participated in an online study through Amazon Mechanical Turk
(MTurk)–a crowdsourcing website (http://www.mturk.com) and were compensated $3.00
CAD. After giving written informed consent, participants completed questionnaires assessing
religiosity, stressor appraisals, coping strategies, and general mental and physical health. The
study was available to people over 18 years of age living in Canada and IP addresses were col-
lected to determine geo-location. Responses included 142 from Ontario (Canada’s most
heavily populated province), 34 from Quebec, 32 from British Columbia, 24 from Alberta, 10
from Nova Scotia, 7 from New Brunswick, 6 from Manitoba, 4 from Saskatchewan, and 1
from Newfoundland and Labrador.
Following the removal of 112 incomplete or invalid survey responses, the final sample
totalled 280 participants (142 men, 137 women, 1 other; ranging in age from 18–72 years,
M = 37.35, SD = 11.19). This sample size provided 95% power to detect medium effect sizes
(two-tailed; [56]), based on our primary analyses (ANOVA and MANOVA) and the most con-
servative estimate is reported for conciseness. Data was collected between March 15th and June
4th, 2021, one full year into the COVID-19 pandemic. Approval from the Carleton University
Research Ethics Board-B (CUREB-B) was obtained prior to the commencement of data
collection.
A demographic questionnaire was also completed by participants, in which they self-identi-
fied their age, gender, ethnic/racial identity, religious affiliation, highest degree or level of edu-
cation, and average annual household income. Participants were then categorized into a (non)
religious group for our primary analyses of interest, with the remaining demographics treated

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as covariates. This categorization resulted in five (non)religious groups, namely Atheists

(n = 69), Agnostics (n = 45), “Spiritual but not religious” (n = 53), Christians (n = 69), and
those who identified as belonging to a variety of religious groups that are considered to be
“Minorities” in Canada (i.e., Bahá’ı́, Buddhist, Hindu, Jewish, Muslim, and Sikh; n = 44).

Measures
Religiosity. The Centrality of Religiosity Scale (CRS) [57] consisted of 13 questions to
measure the general intensities of five theoretically defined dimensions of religiosity. Each
item evaluated the frequency or intensity of the activation of religious constructs, rated on a
scale ranging from 1 (never/not at all) to 5 (very often/very much). These dimensions included
intellectual (e.g., “How often do you think about religious issues?”; 3 items; α = .86); ideology
(e.g., “To what extent do you believe in the existence of God or something divine?”; 3 items; α
= .93); public practice (e.g., “How often do you take part in religious services?”; 3 items; α =
.93); private practice (e.g., “How often do you pray?” 2 items; α = .82); and religious experience
(e.g., “How often do you experience situations in which you have the feeling that God or some-
thing divine intervenes in your life?”; 2 items; α = .94). A total religiosity score based on these
five dimensions was also computed (α = .91).
Stressor appraisals. Stressor appraisals in the context of the COVID-19 pandemic were
evaluated on seven dimensions [58], each consisting of four items rated on a scale ranging
from 1 (not at all) to 5 (extremely). These dimensions included threat appraisals (e.g., “How
threatening is this situation?”; 4 items; α = .75; challenge appraisals (e.g., “Is this going to have
a positive impact on me?”; 4 items; α = .65); centrality appraisals (e.g., “Does this situation
have important consequences for me?”; 4 items; α = .88); appraisals of the situation as control-
lable-by-self (e.g., “Do I have what it takes to do well in this situation?”; 4 items; α = .86); con-
trollable-by-others (e.g., “Is there help available to me for dealing with this problem?”; 4 items;
α = .85); and uncontrollable by anyone (e.g., “Is this a totally hopeless situation?”; 4 items; α =
.80). The final dimension reflected the general stressfulness of the pandemic (e.g., “To what
extent do I perceive this situation as stressful?”; 4 items; α = .78).
Coping. Coping with the COVID-19 pandemic was assessed with the short-version Sur-
vey of Coping Profile Endorsements [59], comprising 30-items, reflecting 15 distinct coping
strategies (e.g. cognitive restructuring, rumination, social-support seeking, denial, etc.). Partic-
ipants rated each item on a scale ranging from 0 (not at all) to 4 (totally). To reduce the num-
ber of coping dimensions a principal components analysis was conducted, which resulted in
four factors. These factors included emotional-engagement coping (e.g., “I told others that I was
really upset”; α = .81); emotional-avoidance (e.g., “I avoided thinking about the problem”; α =
.66); problem-focused coping (e.g., “I made plans to overcome my concerns or the problem”; α
= .70); and religious coping (e.g., “I turned to God or my faith”; single item).
Mental & physical health. Mental health was assessed with a widely used, global single-
item measure [60], which asked participants to rate their current mental health ranging from 1
(poor) to 5 (excellent). To include a more comprehensive view of health, physical health was
also assessed with a single-item measure [61], which asked participants to rate their current
physical health ranging from 1 (poor) to 5 (excellent).

Statistical analyses
A series of analyses of variance (ANOVAs) and multivariate analyses of variances (MANO-
VAs) were conducted to examine potential differences in appraisals, coping, mental and physi-
cal health, and religiosity among the five (non)religious groups. Analyses assessing (non)
religious group differences and relations among stressor appraisals, coping, mental and

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physical health, and religiosity that included age, gender, race, education, and income as covar-
iates yielded identical patterns of significant results. However, given that some participants
chose not to report all demographics, to maximize sample size, the analyses presented here are
those that include (non)religious group as the sole predictor.
Correlations then assessed relations among the variables of interest, and mediation analyses
were conducted to determine whether appraisal-coping processes accounted for the relations
between religiosity and health (i.e., mental and physical). To assess these multiple-mediation
models, we conducted regression-based bootstrapping analyses with 95% confidence intervals
(CIs) using Hayes’ (2022) PROCESS macro (Model 4) [62]; this analysis provides evidence of
mediation if the significant direct effect between the predictor and outcome variable is reduced
when the mediator(s) is included, and the 95% CI does not include zero.

Results
Demographics
Participants in the present study were diverse in terms of gender, age, education, income, eth-
nic, racial, and (non)religious identity. Table 1 presents demographics of this sample as a func-
tion of self-identified (non)religious group membership as well as total numbers across all
(non)religious categories.

Religious group differences in stressor appraisals

A MANOVA assessed whether differences in stressor appraisals (threat, challenge, centrality,
controllable-by-self, controllable-by-others, uncontrollable, and general stressfulness) associ-
ated with the COVID-19 pandemic varied as a function of (non)religious group self-identifica-
tion. This analysis revealed a significant multivariate effect, Pillai’s = 0.206; F(28,1088) = 2.11,
p < .001, η2 = .052, resulting from differences across groups in appraisals of the pandemic as a
challenge, F(4,275) = 4.44, p = .002, η2 = .061, as uncontrollable, F(4,275) = 3.23, p = .002, η2 =
.059, and as controllable by others, F(4,275) = 2.96, p = .020, η2 = .041.
More specifically, as seen in Table 2, Atheists were significantly less likely to view the pan-
demic as a challenge from which they might grow compared to religious “Minorities” (p =
.003) and Christians (p = .018). However, religious “Minorities” were more likely to report
viewing the pandemic as uncontrollable compared to Christians (p = .055) and Agnostics (p =
.002). Finally, Agnostics reported appraisals of the pandemic as controllable-by-others margin-
ally (but not significantly) more than did those who were “Spiritual but not religious” (p =
.094). There were no statistically significant differences across (non)religious groups in
appraisals of the pandemic as central, threatening, controllable-by-self, or as generally
stressful.

Religious group differences in coping

A MANOVA was conducted to assess whether differences in coping strategies (emotional-
engagement, emotional-avoidance, problem-focused, and religious coping) used to manage
stress associated with the COVID-19 pandemic varied as a function of (non)religious group
identity. The analysis revealed a significant multivariate effect, Pillai’s = 0.344; F(16,1096) =
6.45, p < .001, η2 = .086, which appeared to be driven by differences across the (non)religious
groups in religious coping, F(4,274) = 25.67, p < .001, η2 = .273, emotional-engagement, F
(4,274) = 4.56, p = .001, η2 = .062, and problem-focused coping, F(4,274) = 4.44, p = .002, η2 =
.061, but not by emotional-avoidance coping, F(4,274) = 1.79, p = .131, η2 = .025.

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Table 1. Demographics of (non)religious groups.

Atheist Agnostic Spiritual Christian Religious “Minority” Totals
(n = 69) (n = 45) (n = 53) (n = 69) (n = 44)
Gender
Women 26 20 33 23 35 137
Men 43 25 19 46 9 142
Other 0 0 1 0 1
Age
18–29 15 19 8 18 11 60
30–49 47 24 41 32 27 171
50–64 7 2 4 13 6 32
65+ 0 0 0 6 0 6
Education
High school diploma or less 10 11 9 10 5 45
Bachelor’s degree 30 20 30 38 23 141
Master’s degree 12 7 4 7 14 44
PhD or higher 5 1 0 1 0 7
Trade certificate/diploma 11 6 10 13 2 42
Household Income
Less than $25,000 2 3 5 9 6 25
$25,000 - $50,000 12 10 17 12 8 59
$50,000 - $100,000 29 18 22 24 21 114
$100,000 - $200,000 19 10 5 16 7 57
More than $200,000 0 0 2 6 0 8
Prefer not to say 7 4 2 2 2 17
Ethnic/Racial Identity
Asian (i.e. Chinese, Japanese, Korean) 11 11 11 4 3 40
South Asian (i.e. East Indian, Pakistani, Punjabi, Sri Lankan) 1 0 2 1 25 29
South East Asian (i.e. Cambodian, Indonesian, Laotian) 1 4 1 3 4 13
Arabic 6 0 0 1 3 10
Black 0 1 2 3 0 6
South/Latin American 1 1 1 4 0 7
Mexican 0 0 0 0 0 0
Aboriginal 0 0 1 3 0 4
White 49 29 36 52 12 178
https://doi.org/10.1371/journal.pone.0296436.t001

As seen in Table 3, not surprisingly, Christians and religious “Minorities” reported practic-
ing religious coping significantly more than Atheists (ps < .001), Agnostics (ps < .001), and
those who were Spiritual (p = .002 and p < .001, respectively). Interestingly, religious “Minori-
ties” (p < .001) and those who were Spiritual (p = .053), reported significantly more emo-
tional-engagement coping compared to Atheists. Finally, Atheists reported significantly less
problem-focused coping compared to religious “Minorities” (p = .001), Christians (p = .041),
and those who were Spiritual (p = .044).

Religious group differences in self-reported health

An ANOVA revealed self-reported mental health differences across the (non)religious groups
during the COVID-19 pandemic, F(4,275) = 5.34, p < .001, η2 = .072. As seen in Table 4,
Agnostics self-reported poorer mental health than did Christians (p = .002), religious

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Table 2. Stressor appraisals (Means, SDs) as a function of (non)religious group.

Atheist Agnostic Spiritual Christian Religious “Minority” F (4,275) η2
Appraisals (n = 69) (n = 45) (n = 53) (n = 69) (n = 44)
Threat 2.85a (0.88) 3.01a (0.71) 3.17a (0.89) 2.85a (0.82) 3.19a (0.77) 2.28 .032
Challenge 2.39a (0.77) 2.54a,b (0.76) 2.70a,b (0.66) 2.80b (0.81) 2.93b (0.80) 4.44** .061
Centrality 2.97a (0.94) 3.39a (0.82) 3.34a (0.99) 3.24a (0.87) 3.38a (0.86) 2.30 .032
Controllable-by-self 3.37a (0.98) 3.48a (0.75) 3.33a (0.85) 3.66a (0.74) 3.34a (0.78) 1.56 .022
Controllable-by-others 2.97a (0.94) 3.39a (0.78) 2.92a (0.98) 3.31a (0.80) 3.15a (0.85) 2.96* .041
Uncontrollable 2.30a,b (0.85) 1.97a (0.73) 2.47a,b (0.76) 2.19a (0.93) 2.66b (1.02) 4.33** .059
Stressfulness 2.86a (0.89) 2.97a (0.71) 3.20a (0.83) 2.87a (0.92) 3.18a (0.68) 2.16 .030
**
p < .01
*
p < .05; Means in the same row that do not share subscripts differ at p < .05 (with the exception of the difference in controllable-by-others appraisals between religious
“Minorities” and Christians; p = .055).

https://doi.org/10.1371/journal.pone.0296436.t002

“Minorities” (p = .012), and Atheists (p = .050). Also, Christians self-reported significantly bet-
ter mental health than those who were Spiritual (p = .032). However, there were no significant
differences in self-reported mental health among Christians, Atheists, or religious
“Minorities”.
An ANOVA conducted to assess differences in self-reported physical health, revealed a rela-
tively modest non-significant effect, F(4,275) = 2.211, p = .068, n2 = .031, across (non)religious
groups. Specifically, Atheists reported marginally better physical health compared to religious
“Minorities” (p = .089). Clearly, the links to physical health were appreciably weaker than
those related to self-reported mental health.

Group differences in religiosity

The CRS included five dimensions (intellect, ideology, public practice, private practice, and
religious experience). A MANOVA to assess differences across these five dimensions of religi-
osity as a function of (non)religious group identification revealed a significant multivariate
effect, Pillai’s = 0.614; F(20,1096) = 9.93, p < .001, η2 = .153. However, given that the same pat-
tern emerged across all five dimensions (i.e., with Atheists having the lowest levels of religios-
ity, followed by Agnostics, Spirituals, Christians, and religious “Minorities”), subsequent
analyses were conducted using the composite measure of overall religiosity.
To confirm that individuals’ self-reported religiosity reflected their (non)religious group
membership as anticipated, an ANOVA assessed overall religiosity across the groups, which
yielded a significant effect, F(4,275) = 37.83, p < .001, η2 = .355. Predictably, Atheists reported

Table 3. Coping strategies (Means, SDs) as a function of (non)religious group.

Atheist Agnostic Spiritual Christian Religious “Minority” F (4, 274) η2
Coping (n = 68) (n = 45) (n = 53) (n = 69) (n = 44)
Problem-focused 1.93a (0.86) 2.19a,b (0.71) 2.33a,b (0.69) 2.31b (0.76) 2.50b (0.73) 4.44*** .061
Emotional-Engagement 1.19a (0.65) 1.45a,b (0.49) 1.53b (0.61) 1.38a,b (0.71) 1.71b (0.78) 4.56*** .062
Emotional-Avoidance 1.74a (0.77) 2.10a (0.63) 1.99a (0.74) 2.01a (0.85) 1.97a (0.87) 1.79 .025
Religious 0.16 a (0.64) 0.16a (0.47) 0.57a (1.03) 1.33b (1.56) 2.00b (1.44) 25.67*** .273
***
p < .001; Means in the same row that do not share subscripts differ at p < .05 (with the exception of the difference in emotional-engagement coping between Atheists
and those identifying as spiritual; p = .053).

https://doi.org/10.1371/journal.pone.0296436.t003

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Table 4. Mental and physical health (Means, SDs) as a function of (non)religious group.
Atheist Agnostic Spiritual Christian Religious “Minority” F (4,275) η2
(n = 69) (n = 45) (n = 53) (n = 69) (n = 44)
Mental Health 3.26a (0.99) 2.73b (1.09) 2.91a,b (0.92) 3.43a,c (0.95) 3.18a (1.00) 5.34*** .072
Physical Health 3.57a (0.931) 3.31a (0.925) 3.41a (0.649) 3.23a (0.912) 3.14a (0.795) 2.21 .031
***
p < .001; Means in the same row that do not share subscripts differ at p < .05

https://doi.org/10.1371/journal.pone.0296436.t004

having the lowest levels of overall religiosity (M = 1.50, SD = 0.58), followed by Agnostics
(M = 1.69, SD = 0.49), Spirituals (M = 2.12, SD = 0.72), Christians (M = 2.68, SD = 1.08), and
religious “Minorities” (M = 3.09, SD = 0.99).

Relations among religiosity, appraisal-coping processes, and health

Correlations among religiosity, stressor appraisals, coping strategies, and health during the
COVID-19 pandemic were also assessed. Of particular interest were the relations between reli-
giosity and the remaining variables. (Correlations among the stressor appraisals and coping
strategies themselves are presented in S1 Checklist). As seen in Table 5, greater religiosity was
significantly associated with an increased tendency to appraise the COVID-19 pandemic as a
challenge from which one might learn and grow, but not with the other types of stressor
appraisals. Likewise, religiosity was associated with more positive mental (but not physical)
health. Mental health, in turn, was associated with appraising the pandemic as less threatening,
less central, and less stressful in general, while being positively associated with appraising the
pandemic as a challenge or as controllable by oneself or others. The relations between physical
health and stressor appraisals followed a similar pattern, in that better physical health was also
associated with appraising the pandemic as less threatening, less central, and less stressful in
general, while being positively associated with appraising the pandemic as controllable by one-
self (Table 5).
Greater religiosity, as shown in Table 6, was also significantly associated with an increased
tendency to report using problem-focused, emotional-engagement, and religious coping to
deal with the pandemic. Problem-focused and religious coping were, in turn, associated with
greater mental health. Interestingly, however, mental and physical health were both associated
with a decreased tendency to report emotional-engagement coping.

The mediating roles of appraisal-coping processes

Stressor appraisals. When the potential mediating roles of appraisals were assessed in the
relation between religiosity and mental health, the direct relation (c path; [62]), B = .13 SE =
.05, p = .02, remained significant (c’ path), B = .13, SE = .05, p = .01. The 95% CIs for the poten-
tial mediated paths through stressor appraisals each included zero.
When the potential mediating roles of appraisals were assessed in the (non-significant) rela-
tion between religiosity and physical health, the direct relation (c path; [62]), B = -.03, SE = .05,
p = .51, remained non-significant (c’ path), B = -.05, SE = .05, p = .24, and the 95% CIs for the
mediated paths through stressor appraisals each included zero. Thus, stressor appraisals did
not play a mediating role in the relations between religiosity and mental or physical health.
Coping. When the potential mediating roles of coping strategies were assessed in the rela-
tion between religiosity and mental health, the direct relation (c path; [62]), B = .13, SE = .05, p
= .02, was reduced to non-significance (c’ path), B = -.003, SE = .09, p = .97. Moreover, the
95% CIs for the mediated paths through emotional-engagement, B = -.08, SE = .03, 95% CI =

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Table 5. Means, standard deviations, and correlations among religiosity, stressor appraisals, & health.
Variable M SD 2 3 4 5 6 7 8 9 10
1. Religiosity 2.19 0.99 .003 .25** .07 .08 .03 .07 .10 .14* -.04
Stressor Appraisals
2. Threat 2.99 0.83 __ .02 .68** -.22** -.14** .45** .75** -.26** -.30**
3. Challenge 2.66 0.78 __ __ .22** .51** .39** .06 .15* .15* .09
4. Centrality 3.24 0.91 __ __ __ -.02 -.04 .24** .62** -.24** -.29**
5. Controllable-by- 3.46 0.84 __ __ __ __ .56** -.16** -.13* .35** .22**
self
6. Controllable-by-others 3.14 0.89 __ __ __ __ __ -.22** -.09 .24** .08
7. Uncontrollable 2.31 0.89 __ __ __ __ __ __ .34** .03 -.06
8. Stressfulness 2.99 0.84 __ __ __ __ __ __ __ -.29** -.22**
Health
9. Mental 3.18 1.00 __ __ __ __ __ __ __ __ .37**
10. Physical 3.35 0.85 __ __ __ __ __ __ __ __ __
*
p < .05
**
p < .01
***
p < .001

https://doi.org/10.1371/journal.pone.0296436.t005

-.13, -.03, and problem-focused coping, B = .07, SE = .02, 95% CI = .03, .11, did not overlap
zero (Fig 1).
When the potential mediating roles of coping strategies were assessed in the (non-signifi-
cant) relation between religiosity and physical health, the direct relation (c path; [62]), B = -.03,
SE = .05, p = .50, remained non-significant (c’ path), B = .03, SE = .08, p = .76. However, as
with mental health, the 95% CIs for the mediated paths through both emotional-engagement
(B = -.05, SE = .02; CI = -.09, -.02), and problem-focused coping (B = .04, SE = .02; CI = .01,
.08), did not overlap zero (Fig 2). As a mediation model may involve indirect effects between
two variables even in the absence of direct effects [63], emotional-engagement and problem-
focused coping appeared to indirectly link religiosity and physical health. Taken together, the
use of emotional-engagement and problem-focused coping strategies appeared to fully account
for the tendency for more religious individuals to report greater mental health, as well as indi-
rectly link religiosity with greater physical health.

Table 6. Means, standard deviations, and correlations among religiosity, coping strategies, & health.
Variable M SD 2 3 4 5 6 7
1. Religiosity 2.19 0.99 .28** .23** .11 .82** .14* -.04
Coping Strategies
2. Problem-focused 2.23 0.79 __ .39** .44** .22** .15* .04
3. Emotional-engagement 1.42 0.68 __ __ .39** .29** -.22** -.24**
4. Emotional-avoidance 1.95 0.79 __ __ __ .07 -.003 -0.8
5. Religious coping 0.81 1.31 __ __ __ __ .13* -.09
Health
6. Mental 3.18 1.00 __ __ __ __ __ .37**
7. Physical 3.35 0.85 __ __ __ __ __ __
*
p < .05
**
p < .01

https://doi.org/10.1371/journal.pone.0296436.t006

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Fig 1. The mediating role of coping in the relation between religiosity and mental health.
https://doi.org/10.1371/journal.pone.0296436.g001

Discussion
The aim of this research was to examine potential differences in how (non)religious groups
appraised and coped with the COVID-19 pandemic, as well as to assess potential relations
among religious beliefs, stressor appraisals, coping strategies, and mental and physical health
in a religiously-diverse Canadian sample during the pandemic. Given that many countries dif-
fered in their approach to dealing with COVID-19, Canada’s pandemic response was also dis-
tinct in its implementation on several factors. Some of these included stay-at-home and face-
masking requirements, hospital and policy responses, and vaccine rollout, which in turn,
affected the severity of COVID-19 case and death counts. At the time of data collection, stay-
at-home requirements were still in effect, thousands of people were hospitalized with COVID-
19, with over 3000 new cases being reported each day [55]. Thus, the COVID-19 pandemic
was a unique circumstance in which to examine the role of (non)religious group identity on
stressor appraisals, coping, and mental health within a Canadian population. Several variations
emerged across the (non)religious groups in stressor appraisals, coping strategies, and health.
While these differences did not always delineate a clear pattern, Atheists predictably reported
the lowest levels of religiosity, followed by Agnostics, participants who identified as “Spiritual
but not religious”, Christians, and religious “Minorities” reported the highest levels. Religiosity

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Fig 2. The mediating role of coping in the relation between religiosity and physical health.
https://doi.org/10.1371/journal.pone.0296436.g002

essentially appeared to serve as a proxy for increasing engagement with one’s religious group
and belief system (or lack thereof). Moreover, when relations among religiosity, appraisal-cop-
ing processes, and health, as well as the potential mediating roles of appraisals and coping were
examined, our findings are consistent with the suggestion that greater religious beliefs were
tied to better well-being (see [64]) both directly and indirectly through (non-religious) emo-
tional-engagement and problem-focused coping strategies during the pandemic.

The role of religiosity and stressor appraisals in pandemic-related health

It is commonly accepted that the impact of stressful events are typically related to their control-
lability, predictability, uncertainty, and chronicity [65]. These characteristics are consistent
with the nature of the COVID-19 pandemic as an uncontrollable, unpredictable, and chronic
event, including the ongoing threat of the virus itself as well as shifting lockdowns and public
health restrictions. Though not in a pandemic context, previous research has demonstrated
that greater religiosity and positive religious coping were associated with greater use of chal-
lenge appraisals [48], which typically reflect an individuals’ perception that their abilities and
resources are sufficient to cope with the danger of the stressor [66]. The present findings
within the COVID-19 context revealed that greater religiosity was significantly associated with

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an increased tendency to appraise the pandemic as a challenge from which one might learn
and grow. Earlier research had provided evidence that challenge appraisals are strongly associ-
ated with more positive emotional reactions and greater use of cognitive strategies, such as
engaging in positive self-statements and active coping [67]. Furthermore, consistent with pre-
vious research [48, 67], our findings revealed that an increased tendency to appraise the pan-
demic as a challenge was associated with more positive mental health (although appraisals did
not statistically mediate this relation). It is possible that people greater in religiosity may have
been more likely to appraise the pandemic as a challenge given that many religions promote
the belief that there is purpose in difficult circumstances because a transcendent force is in
control of such situations [68]. Of course, within the religious “Minorities” group, some indi-
viduals identified as belonging to a religion that upholds belief in a singular God (i.e., Bahá’ı́,
Jewish, Muslim, or Sikh) which may influence differences in appraising the pandemic as a
challenge, compared to those who identified with a religion in which there are multiple gods
(i.e., Hindu) or no gods at all (i.e., Buddhist). Nonetheless, religious “Minorities” and Chris-
tians were significantly more likely to view the pandemic as a challenge when compared to
Atheists. While we found no evidence of significant associations between religiosity and other
types of stressor appraisals (e.g., threat, centrality), these results support the notion that reli-
gious individuals may have additional capacity to view stressors—including the COVID-19
pandemic—as a challenge rather than as a threat.

The role of religiosity and coping in pandemic-related health

Not surprisingly, individuals with greater religiosity (i.e., Christians and religious “Minori-
ties”) were significantly more likely to report the use of religious coping. Religious coping was,
in turn, associated with greater mental (but not physical) health, in line with previous research
[12, 15, 26, 28, 68, 69]. However, religious individuals are not restricted in the coping methods
used and were also more likely to endorse the use of (non-religious) problem-focused and
emotional-engagement strategies in an effort to deal with pandemic stress. Moreover, both
these coping strategies served a mediating role in linking religiosity with greater mental and
(indirectly) physical health.
Problem-focused coping—typically comprising strategies such as problem-solving, active
coping, and cognitive restructuring—has commonly been linked to higher levels of health and
well-being [70, 71]. This profile was similarly apparent during the COVID-19 pandemic in
that individuals who coped with pandemic-related stress using problem-focused strategies
were more likely to maintain positive well-being [71]. The same was evident in the current
study, with a positive relation emerging between problem-focused coping and mental health.
As previously reported [72, 73], the current study demonstrated that individuals with greater
religiosity also reported an increased tendency to use problem-focused coping to deal with the
pandemic (with Atheists reporting significantly lower levels of this coping strategy compared
to all other groups with the exception of Agnostics). The tendency for religious individuals to
engage in more problem-focused coping is also consistent with earlier research that has sug-
gested links between problem-focused coping and challenge appraisals or social support [74].
Many religious organizations made concerted efforts to foster resilience and maintain social
links with their members online throughout the pandemic, even in the absence of physical
proximity [75]. These virtual communities may have served as a source of instrumental or
informational support [76] for some religious individuals in the context of the pandemic,
potentially encouraging more adaptive ways of thinking about and coping with the pandemic,
which, in turn, accounted for their more positive mental and (indirectly) physical health.

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In addition to problem-focused coping, religiosity was associated with greater use of emo-
tional-engagement coping in the present study, which can include strategies such as emotional
expression and emotional social support-seeking [77, 78]. According to our analyses of group
differences, this relation appeared to be driven largely by those who identified as belonging to
a religious group that is considered a “Minority” in Canada (i.e., Bahá’ı́, Buddhist, Hindu, Jew-
ish, Muslim, and Sikh). Although emotional-engagement styles of coping have previously been
associated with higher levels of well-being [69, 73, 77, 78] our study revealed that emotional-
engagement coping was instead associated with more negative mental and physical health out-
comes. Although our emotional-engagement factor included strategies such as emotional-
expression and social support-seeking, which could have beneficial actions [54, 77, 78], it also
included rumination, other-blame, and wishful thinking—strategies that are generally consid-
ered to be less “adaptive” in coping with stress [79, 80]. In fact, rumination itself has been asso-
ciated with diverse psychological disturbances and predicted the later development of
depression [81]. In this way, our findings are consistent with recent research in which people
with greater religiosity were more likely to “emotionally overreact” and engage in negative
coping behaviours during the COVID-19 pandemic [82].
While some religious individuals may have engaged in more positive emotional-engage-
ment coping strategies, such as seeking social support, others may have relied on less construc-
tive emotional strategies to deal with the pandemic. Indeed, greater religiosity has been
associated with some unreasonable behavioural coping responses to deal with the COVID-19
pandemic (e.g., hoarding toilet paper), which was also linked with increased emotionality [82].
Moreover, the religious “Minorities” group included participants who identified as belonging
to diverse religions, thus differences in religious beliefs as well as differences in the interpreta-
tions and practice of those beliefs (e.g., communal worship), may influence the use of more
positive or negative emotional-engagement coping strategies. For example, individuals who
identified as belonging to religions that observe daily and weekly times of worship (i.e., Jewish
and Muslim), may be more likely to benefit from consistent social support-seeking compared
to those who identified as belonging to religions that observe less frequent and structured
times of communal worship (i.e., Bahá’ı́, Buddhist, Hindu, and Sikh). Indeed, greater religious
participation has long been associated with increased social support [83–85]. Nonetheless,
despite higher levels of religiosity being accompanied by greater emotional-engagement cop-
ing, which was in turn associated with more negative mental and physical health outcomes,
religiosity was significantly associated with more positive mental health. Thus, rather than act-
ing as a direct mediator, emotional-engagement coping appeared to have a suppressor effect
[63, 86] in the (positive) relation between religiosity and mental health, such that this relation
might have been even stronger (and the relation between religiosity and physical health might
have been significant) had it not been for the emotion-focused coping in which religious indi-
viduals were more likely to engage.

Implications for culturally-sensitive pandemic-related health promotion

In addition to illuminating links between religiosity and appraisal-coping processes (including
but not limited to religious coping) at the individual level, this research may have implications
for public health initiatives that aim to encourage culturally-diverse [87] self-care recommen-
dations and positive mental health practices during times of threat and uncertainty, such as
the COVID-19 pandemic or other health crises. Among religious individuals, the positive asso-
ciations among religiosity, religious coping, and mental health outcomes are consistent with
the view that these beliefs may be tied to the endorsement of problem-focused strategies with
integrated religious or spiritual elements. Although the belief common to many religious

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individuals is that seemingly random events can hold purpose or meaning [33, 67] and are in
control by a more powerful transcendent force [88], the benefits of religiosity may also come
from the adoption of specific appraisals of stressors (e.g., viewing events as challenges rather
than threats) and endorsing effective problem-focused coping methods. In the same vein, cog-
nitive restructuring (i.e., reframing one’s interpretation of a situation) may include an element
of religion or spirituality, such as prayer and/or mediation, thereby harnessing the benefits typ-
ically inherent to both active problem-focused and religious coping together.
Despite the use of problem-focused coping, the present study also revealed the tendency for
religious individuals to use emotional-engagement coping, which may be associated with
more negative health outcomes. Thus, it may also be prudent for public health messages to
caution against the use of certain emotional-engagement coping strategies, such as rumina-
tion, denial, or disengagement. While such messaging would be relevant for both religious and
non-religious individuals alike, it may be especially pertinent for religious communities in
which it would be advantageous to help steer them away from negative religious coping strate-
gies (e.g., anger at God/gods), which have been associated with more negative health outcomes
[89]. As religious individuals tend to have formal support networks through their religious
organizations and/or communities [75], promotion of this unique resource may help them to
cope in more effective ways with both emotional and tangible outcomes.
Non-religious individuals who lack religious communities may likewise benefit from
encouragement to engage in social support-seeking and emotional expression with other posi-
tive communities in which they may be involved [9]. Indeed, even without considering reli-
gious identity, greater social connectedness during pandemic lockdown periods was associated
with lower levels of perceived stress, worry, burnout, and fatigue [90, 91]. Moreover, as better
mental health was associated with the use of challenge appraisals and problem-focused coping
when our study sample was examined as a whole (i.e., including both religious and non-reli-
gious individuals), the benefits of engaging in such strategies likely extend within and beyond
religious communities. Indeed, given the broad distress created by the COVID-19 pandemic,
it has been noted that the pandemic may be thought of as a collective trauma [92–94]. As such,
appraising the pandemic as a challenge (rather than a threat) may be associated with post-trau-
matic growth (i.e., significant positive change arising from major life struggles; [95–97]).
Given the potentially long-standing mental health implications of the pandemic, it is impor-
tant that accessible, tailored, and culturally-sensitive public health initiatives adequately
address the needs of people with diverse backgrounds and beliefs.

Limitations
Like most research, this study has several limitations. First, the religious “Minority” group
comprised members from several different religions due to the relatively small number of
respondents who identified as belonging to one of a variety of religious groups considered to
be “Minorities” in Canada. Thus, there may well be important differences (e.g., individualistic
vs. collectivist attitudes or practices; [87]) between these religious groups that were not
detected in the current study. Nonetheless, our inclusion of these broad and often under-rep-
resented religious groups extends previous research that has in many cases considered Chris-
tians alone. Indeed, despite having the least representation within our sample (15.7%),
religious minorities were nonetheless over-represented compared to the national average of
these groups combined (10.4%; [98]). Likewise, Atheists, Agnostics, and “Spirituals” were
over-represented in the current study, perhaps due to the use of MTurk as a data collection
tool (which often elicits younger, more highly-educated participants; [99]), thereby offering a
valuable opportunity with our screening and validity checks in place; [100] to compare

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PLOS ONE Medicine for the soul

responses across these growing (non)religious groups. Relatedly, as a result of the sample sizes
across (non)religious groups, we were unable to adequately assess interactions with gender.
Given previous research suggesting that women tend to report poorer mental health (e.g.,
[101]) and greater religiosity (e.g., [102]) compared to men, as with most research, future stud-
ies would benefit from a larger sample of participants. Nonetheless, our patterns of findings
held constant even when gender (along with age, race, education, and income) was included as
a covariate.
Additionally, mental and physical health were each measured using a single, self-reported
item (notwithstanding the documented predictive value of these single-item measures; [103]).
Likewise, (non)religious group identity and affiliation was based on a single question as part of
the demographic questionnaire, but without a related measure to evaluate the strength of this
non(religious) identity. Despite this, our study did include a more precise measure of religios-
ity, which seemed to capture the relative strength of the identity across the groups (perhaps
with the exception of highly-identified Atheists; [104]). A final limitation of this study is the
inability to compare our results to those from a pre-pandemic context, which may have pro-
vided insight into specific changes in the relations among religiosity, stressor appraisals, cop-
ing, and health outcomes that may have occurred as a result of the pandemic. Although our
study yielded potentially important patterns among religiosity, appraisal-coping processes and
health, given the correlational nature of the data, causal relationships cannot be definitively
determined.

Conclusions
The results of the present study revealed numerous differences in appraisal-coping methods
and health across (non)religious groups. However, the clearest patterns emerged between reli-
giosity and health, where both problem-focused and emotional-engagement coping mediated
these relations. These findings suggest that greater religious belief may contribute to better
mental and physical health, at least in part, through using adaptive (non-religious) coping
strategies. Accordingly, this research may have implications for coping at the individual level,
as well as informing culturally-sensitive public health messages promoting targeted self-care
recommendations with integrated religious or spiritual elements during times of threat and
uncertainty, such as the COVID-19 pandemic or future health crises.

Supporting information
S1 Checklist. STROBE statement—checklist of items that should be included in reports of
observational studies.
(DOCX)

Author Contributions
Conceptualization: Renate Ysseldyk.
Data curation: Claire Peneycad, Emily Tippins.
Formal analysis: Claire Peneycad, Emily Tippins.
Funding acquisition: Renate Ysseldyk.
Investigation: Claire Peneycad, Emily Tippins.
Methodology: Claire Peneycad, Emily Tippins.
Project administration: Emily Tippins.

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PLOS ONE Medicine for the soul

Software: Emily Tippins.

Supervision: Renate Ysseldyk.
Validation: Renate Ysseldyk, Hymie Anisman.
Writing – original draft: Claire Peneycad, Renate Ysseldyk.
Writing – review & editing: Claire Peneycad, Renate Ysseldyk, Hymie Anisman.

References
1. World Health Organization | WHO. WHO Coronavirus (COVID-19) Dashboard [Internet]. [cited 2022
Jan 10]. Available from: https://covid19.who.int/.
2. Dozois DJA, Mental Health Research Canada. (2021). Anxiety and depression in Canada during the
COVID-19 pandemic: A national survey. Can Psychol, 2021; 62(1):136–142.
3. Park CL, Finkelstein-Fox L, Russell BS, Fendrich M, Hutchison M, Becker J. Americans’ distress early
in the COVID-19 pandemic: Protective resources and coping strategies. Psychol Trauma. 2021; 13(4):
422–431. https://doi.org/10.1037/tra0000931 PMID: 33507795
4. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among
Chinese people in the COVID-19 epidemic: Implications and policy recommendations. Gen Psychiatr.
2020; 33(2):e100213. https://doi.org/10.1136/gpsych-2020-100213 PMID: 32215365
5. Budimir S, Probst T, Pieh C. Coping strategies and mental health during COVID-19 lockdown. J Ment
Health. 2021; 30(2):156–163. https://doi.org/10.1080/09638237.2021.1875412 PMID: 33502917
6. Chow SK, Francis B, Ng YH, Naim N, Beh HC, Ariffin MAA, et al. Religious coping, depression and
anxiety among healthcare workers during the COVID-19 pandemic: A Malaysian perspective. Healthc
(Amst). 2021; 9(1):79. https://doi.org/10.3390/healthcare9010079 PMID: 33467744
7. Park CL, Russell BS, Fendrich M, Finkelstein-Fox L, Hutchison M, Becker J. Americans’ COVID-19
stress, coping, and adherence to CDC guidelines. J. Gen. Intern. Med. 2020; 35(8):2296–2303.
https://doi.org/10.1007/s11606-020-05898-9 PMID: 32472486
8. Draru MC, Lopatofsky T, Karimi K, Gautier ML. Understanding coping mechanisms during the COVID-
19 pandemic: A case study of stakeholders of the African Sisters Education Collaborative. Rev. Relig.
Res. 2022; 64(2):325–342. https://doi.org/10.1007/s13644-022-00488-z PMID: 35431345
9. Haslam SA, Jetten J, Postmes T, Haslam C. Social identity, health and well-being: An emerging
agenda for applied psychology. Appl. Psychol. Int. Rev. 2009; 58(1):1–23.
10. Ysseldyk R, Talebi M, Matheson K, Bloemraad I, Anisman H. Religious and ethnic discrimination: Dif-
ferential implications for social support engagement, civic involvement, and political consciousness. J.
Soc. Political. Psychol. 2014; 2:347–376.
11. Folkman S. Stress: Appraisal and coping. 2013. p. 1913–1915.
12. Fatima S, Arshad M, Mushtaq M. Religious coping and young adult’s mental well-being during Covid-
19: Testing a double moderated mediation model. Arch Psychol Relig. 2022;1–20.
13. Mahamid FA, Bdier D. The association between positive religious coping, perceived stress, and
depressive symptoms during the spread of coronavirus (COVID-19) among a sample of adults in Pal-
estine: A cross-sectional study. J Relig Health. 2021; 60(1):34–49. https://doi.org/10.1007/s10943-
020-01121-5 PMID: 33389439
14. Pargament KI, Smith BW, Koenig HG, Perez L. Patterns of positive and negative religious coping with
major life stressors. J Sci Study Relig. 1998; 37(4):710–724.
15. Park CL, Holt CL, Le D, Christie J, Williams BR. Positive and negative religious coping styles as pro-
spective predictors of well-being in African Americans. Psychol Relig Spiritual. 2018; 10(4):318–326.
https://doi.org/10.1037/rel0000124 PMID: 30505376
16. Finkelstein-Fox L, Park CL. Control-coping goodness-of-fit and chronic illness: A systematic review of
the literature. Health Psychol Rev. 2019; 13(2):137–162. https://doi.org/10.1080/17437199.2018.
1560229 PMID: 30558475
17. Rafferty KA, Billig AK, Mosack KE. Spirituality, religion, and health: The role of communication,
appraisals, and coping for individuals living with chronic illness. J Relig Health. 2015; 54(5), 1870–
1885. https://doi.org/10.1007/s10943-014-9965-5 PMID: 25341570

PLOS ONE | https://doi.org/10.1371/journal.pone.0296436 January 2, 2024 17 / 21

PLOS ONE Medicine for the soul

18. Taha S, Matheson K, Cronin T, Anisman H. Intolerance of uncertainty, appraisals, coping, and anxiety:
The case of the 2009 H1N1 pandemic. Br J Health Psychol. 2014; 19(3):592–605. https://doi.org/10.
1111/bjhp.12058 PMID: 23834735
19. Bergman YS, Cohen-Fridel S, Shrira A, Bodner E, Palgi Y. COVID-19 health worries and anxiety
symptoms among older adults: The moderating role of ageism. Int Psychogeriatr. 2020; 32(11):1371–
1375. https://doi.org/10.1017/S1041610220001258 PMID: 32613924
20. Yip P, Cheung YT, Chau PH, Law YW. The impact of epidemic outbreak. J Crisis Interv Suicide Prev.
2010; 31(2).
21. Kharroubi S, Saleh F. Are lockdown measures effective against COVID-19? Front Public Health.
2020; 8:549692. https://doi.org/10.3389/fpubh.2020.549692 PMID: 33194950
22. Sprang G, Silman M. Posttraumatic stress disorder in parents and youth after health-related disasters.
Disaster Med Public Health Prep. 2013; 7(1):105–110. https://doi.org/10.1017/dmp.2013.22 PMID:
24618142
23. Bankier-Karp AL, Shain M. COVID-19’s effects upon the religious group resources, psychosocial
resources, and mental health of Orthodox Jews. J Sci Study Relig. 2022; 61(1):197–216.
24. Janssen F, Bänziger S, Dezutter J, Hutsebaut D. Religion and mental health: Aspects of the relation
between religious measures and positive and negative mental health. Arch Psychol Relig. 2005; 27
(1):19–44.
25. Litalien M, Atari DO, Obasi I. The influence of religiosity and spirituality on health in Canada: A system-
atic literature review. J Relig Health. 2022; 61(1):373–414. https://doi.org/10.1007/s10943-020-01148-
8 PMID: 33409859
26. Schnabel L, Schieman S. Religion protected mental health but constrained crisis response during cru-
cial early days of the COVID-19 pandemic. J Sci Study Relig. 2022; 61(2):530–543. https://doi.org/10.
1111/jssr.12720 PMID: 34230686
27. Shiah YJ, Chang F, Chiang SK, Lin IM, Tam WCC. Religion and health: Anxiety, religiosity, meaning of
life and mental health. J Relig Health. 2015; 54: 35–45. https://doi.org/10.1007/s10943-013-9781-3
PMID: 24132457
28. Magin ZE, David AB, Carney LM, Park CL, Gutierrez IA, George LS. Belief in God and psychological
distress: Is it the belief or certainty of the belief? Relig. 2021; 12(9): 757.
29. Park CL. Making sense of the meaning literature: An integrative review of meaning making and its
effects on adjustment to stressful life events. Psychol Bull. 2010; 136(2):257–301. https://doi.org/10.
1037/a0018301 PMID: 20192563
30. Héliot Y, Gleibs IH, Coyle A, Rousseau DM, Rojon C. Religious identity in the workplace: A systematic
review, research agenda, and practical implications. Hum Resour Manag J. 2020; 59(2):153–173.
31. Mavor K, Ysseldyk R. A social identity approach to religion: Religiosity at the nexus of personal and
collective self. In: Vail K, Routledge C, editors. The Science of Religion, Spirituality, and Existentialism.
Elsevier Academic Press; 2020. p. 187–206.
32. Muldoon OT, Haslam SA, Haslam C, Cruwys T, Kearns M, Jetten J. The social psychology of
responses to trauma: Social identity pathways associated with divergent traumatic responses. Eur
Rev Soc Psychol. 2019; 30(1):311–348.
33. Park CL. Religiousness/spirituality and health: A meaning systems perspective. J Behav Med. 2007;
30(4):319–328. https://doi.org/10.1007/s10865-007-9111-x PMID: 17522971
34. Ysseldyk R, Matheson K, Anisman H. Religiosity as identity: Toward an understanding of religion from
a social identity perspective. Pers Soc Psychol Rev. 2010; 14:60–71. https://doi.org/10.1177/
1088868309349693 PMID: 20089847
35. McCullough ME, Willoughby BLB. Religion, self-regulation, and self-control: Associations, explana-
tions, and implications. Psychol Bull. 2009; 135(1):69–93. https://doi.org/10.1037/a0014213 PMID:
19210054
36. Hackney CH, Sanders GS. Religiosity and mental health: A meta-analysis of recent studies. J Sci
Study Relig. 2003; 42(1):43–55.
37. Balbuena L, Baetz M, Bowen R. Religious attendance, spirituality, and major depression in Canada: A
14-year follow-up study. Can J Psychiatry. 2013; 58(4): 225–232. https://doi.org/10.1177/
070674371305800408 PMID: 23547646
38. Dilmaghani M. Importance of religion or spirituality and mental health in Canada. J Relig Health. 2018;
57(1):120–135. https://doi.org/10.1007/s10943-017-0385-1 PMID: 28315988
39. Merath K, Kelly PE, Hyer JM, Mehta R, Agne JL, Deans K, et al. Patient perceptions about the role of
religion and spirituality during cancer care. J Relig Health. 2020; 59(4):1933–1945. https://doi.org/10.
1007/s10943-019-00907-6 PMID: 31482443

PLOS ONE | https://doi.org/10.1371/journal.pone.0296436 January 2, 2024 18 / 21

PLOS ONE Medicine for the soul

40. Peres MFP, Kamei HH, Tobo PR, Lucchetti G. Mechanisms behind religiosity and spirituality’s effect
on mental health, quality of life and well-being. J Relig Health. 2018; 57(5):1842–1855. https://doi.org/
10.1007/s10943-017-0400-6 PMID: 28444608
41. Ysseldyk R, Matheson K, Anisman H. Coping with identity threat: The role of religious orientation and
implications for emotions and action intentions. Psychol Relig Spiritual. 2011; 3(2):132–148.
42. Burker EJ, Evon DM, Sedway AJ, Egan T. Religious and non-religious coping in lung transplant candi-
dates: Does adding god to the picture tell us more? J Behav Med. 2005; 28(6):513–526. https://doi.
org/10.1007/s10865-005-9025-4 PMID: 16237611
43. Pargament KI. The Psychology of Religion and Coping: Theory, Research, Practice. Guilford
Press; 1997.
44. Spilka B, Ladd KL. The psychology of prayer: A scientific approach. Guilford Press; 2012.
45. Exline JJ, Park CL, Smyth JM, Carey MP. Anger toward God: Social-cognitive predictors, prevalence,
and links with adjustment to bereavement and cancer. J Pers Soc Psychol. 2011; 100(1):129–148.
https://doi.org/10.1037/a0021716 PMID: 21219078
46. Ano GG, Vasconcelles EB. Religious coping and psychological adjustment to stress: A meta-analysis.
J Clin Psychol. 2005; 61(4):461–480. https://doi.org/10.1002/jclp.20049 PMID: 15503316
47. Koenig HG. Religion and mental health: Research and clinical applications. London: Academic
Press. 2018.
48. Maltby J, Day L. Religious orientation, religious coping and appraisals of stress: Assessing primary
appraisal factors in the relationship between religiosity and psychological well-being. Pers Individ Dif.
2003; 34(7):1209–1224.
49. Park CL. Exploring relations among religiousness, meaning, and adjustment to lifetime and current
stressful encounters in later life. Anxiety Stress Coping. 2006; 19(1):33–45.
50. Bentzen JS. In crisis we pray: Religiosity and the COVID-19 pandemic. Centre for Economic Policy
Research, COVID Economics 20. 2020. 14824.
51. Pirutinsky S, Cherniak AD, Rosmarin DH. COVID-19, mental health, and religious coping among
American orthodox Jews. J Relig Health. 2020; 59(5):2288–2301. https://doi.org/10.1007/s10943-
020-01070-z PMID: 32705481
52. Agadjanian A, Siekierski K. Religion and pandemic: Shifts of interpretation, popular lore, and practices.
An introduction. Entangled Relig. 2022; 12(3).
53. Baker JO, Martı́ G, Braunstein R, Whitehead AL, Yukich G. Religion in the age of social distancing:
How COVID-19 presents new directions for research. Sociol Relig. 2020; 81(4):357–370. https://doi.
org/10.1093/socrel/sraa039 PMID: 34191911
54. Upenieks L. Religious/spiritual struggles and well-being during the COVID-19 pandemic: Does “talking
religion” help or hurt? Rev Relig Res. 2022; 64(2):249–278. https://doi.org/10.1007/s13644-022-00487-
0 PMID: 35431346
55. Mathieu E, Ritchie H, Rodés-Guirao L, Appel C, Giattino C, Hasell J, et al. “Coronavirus Pandemic
(COVID-19).” OurWorldInData.org, 2020, https://ourworldindata.org/coronavirus
56. Erdfelder E, Faul F, Buchner A, Lang GA. (2009) Statistical power analyses using G-power 3.1: Tests
for correlation and regression analyses. Behavior Research Methods 41: 1149–1160. https://doi.org/
10.3758/BRM.41.4.1149 PMID: 19897823
57. Huber S, Huber OW. The centrality of religiosity scale (CRS). Religions. 2012; 3(3):710–724.
58. Peacock EJ, Wong PP. The Stress Appraisal Measure (SAM): A multidimensional approach to cogni-
tive appraisal. Stress Med. 1990; 6(3):227–236.
59. Matheson K, Anisman H. Systems of Coping Associated with Dysphoria, Anxiety and Depressive Ill-
ness: A Multivariate Profile Perspective, Stress. 2003; 6:3:223–234.
60. Ahmad F, Jhaji AK, Stewart DE, Burghardt M, Bierman AS. Single item measures of self-rated mental
health: A scoping review. BMC Health Serv Res. 2014; 14(1): 398. https://doi.org/10.1186/1472-6963-
14-398 PMID: 25231576
61. Idler EL, Benyamini Y. Self-rated health and mortality: A review of twenty-seven community studies. J
Health Soc Behav. 1997; 38(1):21–37. PMID: 9097506
62. Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis. Guilford Publica-
tions; 2022.
63. Agler R, De Boeck P. On the interpretation and use of mediation: Multiple perspectives on mediation
analysis. Front Psychol. 2017;8.
64. Hoogeveen S, Sarafoglou A, Aczel B, Aditya Y, Alayan AJ, Allen PJ, et al. A many-analysts approach
to the relation between religiosity and well-being. Relig Brain Behav. 2022;1–47.

PLOS ONE | https://doi.org/10.1371/journal.pone.0296436 January 2, 2024 19 / 21

PLOS ONE Medicine for the soul

65. Anisman H, Merali Z. Understanding stress: Characteristics and caveats. Alcohol Research & Health:
Alcohol Res Health. 1999; 23(4):241–249.
66. Tomaka J, Blascovich J, Kelsey RM, Leitten CL. Subjective, physiological, and behavioural effects of
threat and challenge appraisal. J Pers Soc Psychol. 1993; 65(2):248–260.
67. Wang Y, Jackson T, Cai L. Causal effects of threat and challenge appraisals on coping and pain per-
ception. Eur J Pain. 2016; 20(7):1111–1120. https://doi.org/10.1002/ejp.835 PMID: 26773726
68. Koenig HG. Religion, spirituality, and health: The research and clinical implications. ISRN Psychiatry.
2012; 278730:1–33. https://doi.org/10.5402/2012/278730 PMID: 23762764
69. Mueller PS, Plevak DJ, Rummans TA. Religious involvement, spirituality, and medicine: Implications
for clinical practice. Mayo Clin Proc. 2001; 76(12):1225–1235. https://doi.org/10.4065/76.12.1225
PMID: 11761504
70. Ehring T, Quack D. Emotion regulation difficulties in trauma survivors: The role of trauma type and
PTSD symptom severity. Behav Ther. 2010; 41(4):587–598. https://doi.org/10.1016/j.beth.2010.04.
004 PMID: 21035621
71. Gotmann A, Bechtoldt MN. Coping with COVID-19 –Longitudinal analysis of coping strategies and the
role of trait mindfulness in mental well-being. Pers Individ Dif. 2021; 175:110695 https://doi.org/10.
1016/j.paid.2021.110695 PMID: 33531724
72. Krägeloh CU, Chai PPM, Shepherd D, Billington R. How religious coping is used relative to other cop-
ing strategies depends on the individual’s level of religiosity and spirituality. J Relig Health. 2012; 51
(4):1137–1151. https://doi.org/10.1007/s10943-010-9416-x PMID: 21042859
73. Molen KV, Fogarty K, Mcgrady M, Lagerwey M. Religious problem-solving styles and self-efficacy with
problem-focused coping in a faith-based poverty alleviation programme. Ment Health Relig Cult. 2020;
23(10):888–901.
74. Chao RCL. Managing stress and maintaining well-being: Social support, problem-focused coping, and
avoidant coping. J Couns Dev. 2011; 89(3): 338–348.
75. Kühle L, Larsen TL. ‘Forced’ online religion: Religious minority and majority communities’ media usage
during the COVID-19 lockdown. Religions. 2021; 12(7):496.
76. Shakespeare-Finch J, Obst PL. The development of the 2-way social support scale: A measure of giv-
ing and receiving emotional and instrumental support. J Pers Assess. 2011; 93(5):483–490. https://
doi.org/10.1080/00223891.2011.594124 PMID: 21859288
77. Carver CS. Active Coping; 2014. p. 16–19.
78. Jacobi CJ, Vaidyanathan B, Andronicou M. Mental health correlates of sharing private problems in
congregations during the COVID-19 pandemic. J Sci Study Relig. 2022; 61(2):553–563.
79. Fariddanesh M, Rezaei AM. Predicting the happiness of adolescents based on coping styles and reli-
gious attitudes. J Relig Health. 2019; 58(2):537–553. https://doi.org/10.1007/s10943-017-0497-7
PMID: 29022238
80. Hong RY. Worry and rumination: Differential associations with anxious and depressive symptoms and
coping behavior. Behav Res Ther. 2007; 45(2):277–290. https://doi.org/10.1016/j.brat.2006.03.006
PMID: 16635479
81. Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking rumination. Perspect Psychol Sci. 2008; 3
(5):400–424. https://doi.org/10.1111/j.1745-6924.2008.00088.x PMID: 26158958
82. Kranz D, Niepel C, Botes E, Greiff S. Religiosity predicts unreasonable coping with COVID-19. Psychol
Relig Spiritual. 2020; 15(1).
83. Ellison CG, George LK. Religious involvement, social ties, and social support in a Southeastern com-
munity. JSSR, 1994; 33(1):46–61.
84. Hastings OP. Not a lonely crowd? Social connectedness, religious service attendance, and the spiri-
tual but not religious. Soc Sci Res. 2016;(57):63–79.
85. Bradley CS, Hill TD, Burdette AM, Mossakowski KN, Johnson RJ. Religious attendance and social
support: Integration or selection? Rev Relig Res. 2020; 62(1):83–99.
86. MacKinnon DP, Krull JL, Lockwood CM. Equivalence of the mediation, confounding and suppression
effect. Prev Sci. 2000; 1(4):173 https://doi.org/10.1023/a:1026595011371 PMID: 11523746
87. Saroglou V, Clobert M, Cohen AB, Johnson KA, Ladd KL, Van Pachterbeke M, et al. Believing, bond-
ing, behaving, and belonging: The cognitive, emotional, moral, and social dimensions of religiousness
across cultures. J Cross Cult Psychol. 2020; 51(7–8):551–575.
88. Kay AC, Gaucher D, McGregor I, Nash K. Religious belief as compensatory control. Pers Soc Psychol
Rev. 2020; 14(1):37–48.
89. Grubbs JB, Exline JJ, Campbell WK. I deserve better and god knows it! Psychological entitlement as a
robust predictor of anger at God. Psychol Relig Spiritual. 2013; 5(3):192–200.

PLOS ONE | https://doi.org/10.1371/journal.pone.0296436 January 2, 2024 20 / 21

PLOS ONE Medicine for the soul

90. Nitschke JP, Forbes PAG, Ali N, Cutler J, Apps MAJ, Lockwood PL, et al. Resilience during uncer-
tainty? Greater social connectedness during COVID-19 lockdown is associated with reduced distress
and fatigue. Br J Health Psychol. 2021; 26(2):553–569. https://doi.org/10.1111/bjhp.12485 PMID:
33099800
91. Yıldırım M, Çiçek İ, Şanlı ME. Coronavirus stress and COVID-19 burnout among healthcare staffs:
The mediating role of optimism and social connectedness. Curr Psychol. 2021; 40(11):5763–5771.
https://doi.org/10.1007/s12144-021-01781-w PMID: 33935470
92. Muldoon OT. Collective trauma. In Jetten J, Reicher SD, Haslam SA, Cruwys T, editors. Together
Apart: The Psychology of COVID-19. SAGE Publications; 2020. p. 69–72.
93. Stanley BL, Zanin AC, Avalos BL, Tracy SJ, Town S. Collective emotion during collective trauma: A
metaphor analysis of the COVID-19 pandemic. Qual Health Res. 2021; 31(10):1890–1903. https://doi.
org/10.1177/10497323211011589 PMID: 33980096
94. Watson MF, Bacigalupe G, Daneshpour M, Han W, Parra-Cardona R. COVID-19 interconnectedness:
Health inequity, the climate crisis, and collective trauma. Fam Process. 2020; 59(3):832–846. https://
doi.org/10.1111/famp.12572 PMID: 32589267
95. Finstad GL, Giorgi G, Lulli LG, Pandolfi C, Foti G, León-Perez JM, et al. Resilience, coping strategies
and posttraumatic growth in the workplace following COVID-19: A narrative review on the positive
aspects of trauma. Int J Environ Res Public Health. 2021; 18(18):9453. https://doi.org/10.3390/
ijerph18189453 PMID: 34574378
96. Waters L, Cameron K, Nelson-Coffey SK, Crone DL, Kern ML, Lomas T, et al. Collective wellbeing
and posttraumatic growth during COVID-19: How positive psychology can help families, schools, work-
places and marginalized communities. J Posit Psychol. 2021; 1–29.
97. Yan S, Yang J, Ye M, Chen S, Xie C, Huang J, et al. Post-traumatic growth and related influencing fac-
tors in discharged COVID-19 patients: A cross-sectional study. Health Psychol. 2021;12. https://doi.
org/10.3389/fpsyg.2021.658307 PMID: 34122242
98. Statistics Canada. Religion in Canada. October 28, 2021. Available from: https://www150.statcan.gc.
ca/n1/pub/11-627-m/11-627-m2021079-eng.htm
99. Castille CM, Avet S, Daigle K. Comparing MTurk and the US population’s occupational diversity. PLoS
One. 2019; 15(5):e0216512.
100. Chmielewski M, Kucker SC. An MTurk crisis? Shifts in data quality and the impact on study results.
Social Psychol Pers Sci. 2020; 11(4):464–473.
101. Salk RH, Hyde JS, Abramson LY. Gender differences in representative national samples: Meta-analy-
ses of diagnoses symptoms. Psychol Bull. 2017; 143(8):783–822.
102. Baker JO, Whitehead AL. Gendering (non)religion: Politics, education, and gender gaps in secularity
in the United States. Soc Forces. 2016; 94(4):1623–1645.
103. Idler EL. Religion and aging in the global context of secularization: Patterns, processes, conse-
quences. In Ferraro KF, Carr D, editors. Handbook of aging and the social sciences. 9th ed. Aca-
demic Press; 2021. p. 55–268.
104. Mackey CD, Silver CF, Rios K, Cowgill CM, Hood RW. Concealment of nonreligious identity: Exploring
social identity threat among atheists and other nonreligious individuals. Group Process Intergroup
Relat. 2021; 24(5):860–877.

PLOS ONE | https://doi.org/10.1371/journal.pone.0296436 January 2, 2024 21 / 21

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