Are changes in positive mental health associated with increased likelihood of depression over a two year period? A test of the mental health promotion and protection hypotheses.

Journal Article (Journal Article)

This paper investigates the mental health promotion and protection (MHPP) model of reducing depression. Data are from the Clergy Health Initiative Longitudinal Survey of United Methodist ministers in North Carolina that included the Mental Health Continuum Short Form (MHC-SF) for positive mental health and the Patient Health Questionnaire (PHQ-9) for depression in 2014 and 2016 (N = 955). The promotion hypothesis predicts reduced risk of depression in 2016 among clergy whose mental health increased to flourishing and the increased risk of depression in 2016 for clergy who stayed not flourishing. The protection hypothesis predicts increased risk of depression in 2016 for clergy who were flourishing in 2014 but went down to 'not flourishing' in 2016. The reference group is clergy who stayed flourishing. We used modified Poisson regression models for binary outcomes to estimate Prevalence Ratios (PR) and to estimate Incidence Rate Ratios (IRR) of depression in 2016 associated with changes in mental health status. Results support both hypotheses. Compared to clergy who stayed flourishing, clergy who improved to flourishing were as likely, while clergy who stayed not flourishing were nearly seven times more likely, to have depression in 2016. Clergy who declined to not flourishing were six times more likely to have depression in 2016 compared to those who stayed flourishing. Similar patterns were observed when the sample was restricted to clergy without depression in 2014. These findings suggest focusing on MHPP as a complementary approach to treatment to reduce the incidence, prevalence and burden of depression.

Full Text

Duke Authors

Cited Authors

  • Keyes, CLM; Yao, J; Hybels, CF; Milstein, G; Proeschold-Bell, RJ

Published Date

  • June 1, 2020

Published In

Volume / Issue

  • 270 /

Start / End Page

  • 136 - 142

PubMed ID

  • 32339105

Electronic International Standard Serial Number (EISSN)

  • 1573-2517

Digital Object Identifier (DOI)

  • 10.1016/j.jad.2020.03.056


  • eng

Conference Location

  • Netherlands