MENTAL HEALTH AMONG WOMEN IN ACCRA: THE EFFECTS 
OF RELIGIOSITY, SOCIAL SUPPORT AND SOCIAL NEGATIVITY 
 
 
THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON 
 
 
BY 
ETHEL AKPENE ATEFOE 
(10226600) 
 
IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF 
MPHIL PSYCHOLOGY DEGREE  
 
 
 
JULY, 2013
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DECLARATION 
This is to certify that this thesis is the result of research undertaken by Ethel Akpene 
Atefoe towards the award of the Master of Philosophy Degree in the Department of 
Psychology, University of Ghana. 
 
………………………………………. 
ETHEL AKPENE ATEFOE 
(STUDENT) 
 
 
……………………….. 
DATE 
 
 
……………………………                                                    ……………………………. 
DR. SAMUEL ATINDANBILA                                              PROF. CHARITY AKOTIA 
(PRINCIPAL SUPERVISOR)                                                           (CO-SUPERVISOR) 
 
…………………………………     ………………………. 
                DATE         DATE 
  
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ABSTRACT 
The present study seeks to find out the influence of religiosity, social support, social 
negativity and selected demographic variables on the mental health of women in Accra. A 
total of two hundred (200) women living in Accra at the time of data collection were used 
in a cross-sectional survey. Ninety-two (46%) of the participants had a history of various 
mental illnesses and were reporting for review at the Accra psychiatric and Pantang 
hospitals. One hundred and eight (54%) had no history of mental illness and reside or 
work in Adenta, Madina and Legon communities. Data was collected on participants’ 
demographic characteristics and history of mental illness using Demographic 
questionnaire and Mental Health Screening Form III (MHSF-III), the Mental Health 
Inventory (MHI-38) was used to measure their mental health, religiosity, social support 
and social negativity were also assessed using the Santa Clara Strength of Religious Faith 
Questionnaire (SCSRFQ), Multidimensional Scale of Perceived Social Support (MSPSS) 
and Social negativity questionnaire respectively. Results from Pearson Product moment 
correlation, multiple regression and Multivariate analysis of variance revealed that 
religiosity had a significant positive relationship with psychological well-being and 
overall mental health index and a significant negative relationship with psychological 
distress. Perceived social support did not have a significant relationship with the mental 
health outcomes, social negativity however had significant negative influence on mental 
health such that those who reported high social negativity reported poorer mental health 
than those who reported low social negativity. Perceived stress moderated the relationship 
between religiosity and mental health. Among the demographic variables, only education 
predicted mental health significantly. History of mental illness did not make any 
significant difference in participants’ level of religiosity, social support and social 
negativity and did not moderate their influence on mental health. It was also found that 
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religiosity predicted more variance in psychological well-being than social negativity. 
Findings and limitations are discussed in relation to theories and earlier research. It is 
suggested that further research is needed to find out the specific mechanisms involved in 
the relationships between religiosity, social negativity and mental health.  
  
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DEDICATION 
This thesis is dedicated to my late dad, Mr. Edem Atefoe. You went all out for me to 
realize my dreams and you were ready to do even more, but the Lord called you into his 
eternal bosom. Your support and the great faith you had in me brought me this far and I 
am so grateful. I know you are happy and proud wherever you are that the work you 
started has been brought to a successful end. God richly bless you! Rest in perfect peace!! 
 
 
 
 
 
 
 
 
 
  
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ACKNOWLEDGEMENT 
Indeed He who began a good work in us will bring it to an expected end; thanks to God 
almighty for His faithfulness through it all.   
My profound gratitude also goes to my mum (Miss Christine N. Quartey) for her support. 
She has been there for me; listening to my complaints, supporting, encouraging and 
praying with me all the way to the end.  
I would also like to thank my supervisors; Dr. Samuel Atindanbila and Dr. Charity Akotia 
for their time, energy, patience and direction from the beginning to the completion of this 
research; I very much appreciate their efforts. 
My special thanks also go to the Chief Psychiatrist, DDNS and all the staff of the Accra 
Psychiatric hospital and the Medical Director and the ethics committee chairman of 
Pantang Hospital for their immense support during my data collection. 
Finally to all my friends and course mates who helped in one way or the other towards the 
success of this research, I say a big “thank you”. 
 
 
 
 
 
  
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 TABLE OF CONTENTS  
CONTENT                                  PAGE 
DECLARATION ................................................................................................................... i 
ABSTRACT .......................................................................................................................... ii 
DEDICATION ..................................................................................................................... iv 
ACKNOWLEDGEMENT .................................................................................................... v 
TABLE OF CONTENTS ..................................................................................................... vi 
LIST OF FIGURES ............................................................................................................. ix 
LIST OF TABLES ................................................................................................................ x 
LIST OF ABBREVIATIONS .............................................................................................. xi 
CHAPTER ONE ................................................................................................................... 1 
INTRODUCTION ................................................................................................................ 1 
1.1 Background to the Study ................................................................................................. 1 
1.2 Statement of the Problem ................................................................................................ 7 
1.3 Aims and Objectives of the Study ................................................................................. 10 
1.4 Relevance of the Study.................................................................................................. 11 
CHAPTER TWO ................................................................................................................ 12 
LITERATURE REVIEW.................................................................................................... 12 
2.1 Introduction ................................................................................................................... 12 
2.2 Theoretical Framework ................................................................................................. 12 
2.2.1 Stressor Reduction/Prevention Model (Ellison, 1994; Grasmick, Bursik & 
Cochran, 1991) ................................................................................................................ 13 
2.2.2 Religious Coping Theory (Pargament, 1997) ......................................................... 14 
2.2.3 Stress and Coping Perspective (Lakey & Cohen, 2000) ........................................ 15 
2.3 Review of Related Studies ............................................................................................ 18 
2.3.1 Religiosity and Mental Health ................................................................................ 18 
2.3.2 Social Relationships/Interactions and Mental Health ............................................ 26 
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2.4 Summary ....................................................................................................................... 37 
2.5 Rationale of the Study ................................................................................................... 38 
2.6 Statement of Hypotheses ............................................................................................... 40 
2.7 Hypothesized Conceptual Model .................................................................................. 42 
2.8 Operational Definition of Terms ................................................................................... 43 
CHAPTER THREE ............................................................................................................. 44 
METHODOLOGY .............................................................................................................. 44 
3.1 Introduction ................................................................................................................... 44 
3.2 Population ..................................................................................................................... 44 
3.3 Sampling Technique...................................................................................................... 45 
3.4 Sample ........................................................................................................................... 45 
3.5 Inclusion and Exclusion Criteria ................................................................................... 48 
3.6 Measures ....................................................................................................................... 48 
3.7 Research Design ............................................................................................................ 53 
3.8 Procedure....................................................................................................................... 53 
RESULTS ........................................................................................................................... 56 
4.1 Descriptive Statistics ..................................................................................................... 56 
4.2 Hypotheses Testing ....................................................................................................... 58 
4.3 Additional Findings ....................................................................................................... 65 
4.4 Summary of Findings .................................................................................................... 65 
4.5 Observed Conceptual Model ......................................................................................... 67 
CHAPTER FIVE ................................................................................................................. 68 
DISCUSSION ..................................................................................................................... 68 
5.1 Introduction ................................................................................................................... 68 
5.2 Discussion of Findings .................................................................................................. 69 
5.3 Limitations .................................................................................................................... 76 
5.4 Recommendations ......................................................................................................... 77 
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REFERENCES .................................................................................................................... 80 
APPENDIX A ................................................................................................................. 98 
DEMOGRAPHIC QUESTIONNAIRE .......................................................................... 98 
APPENDIX B ................................................................................................................ 100 
MENTAL HEALTH SCREENING FORM III (MHSF-III) ......................................... 100 
APPENDIX C ................................................................................................................ 103 
SANTA CLARA STRENGTH OF RELIGIOUS FAITH QUESTIONNAIRE ........... 103 
APPENDIX D ............................................................................................................... 104 
PERCEIVED STRESS SCALE .................................................................................... 104 
APPENDIX E ................................................................................................................ 105 
SOCIAL NEGATIVITY QUESTIONNAIRE .............................................................. 105 
APPENDIX F ................................................................................................................ 106 
MENTAL HEALTH INVENTORY ................................................................................. 106 
APPENDIX G ................................................................................................................... 111 
CONSENT FORM ........................................................................................................ 111 
APPENDIX H ................................................................................................................... 114 
ETHICAL APPROVAL ................................................................................................... 114 
APPENDIX I ................................................................................................................. 115 
SOCIAL SUPPORT SCALE ............................................................................................ 115 
APPENDIX J ................................................................................................................. 116 
CONFIRMATORY FACTOR ANALYSIS FOR THE COMPONENTS OF THE 
SOCIAL NEGATIVITY QUESTIONNAIRE .............................................................. 116 
APPENDIX K ............................................................................................................... 117 
MULTIPLE REGRESSION ANALYSIS OF THE CONTRIBUTIONS OF 
RELIGIOSITY AND SOCIAL NEGATIVITY ON PSYCHOLOGICAL WELL-BEING
 ........................................................................................................................................... 117 
 
 
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LIST OF FIGURES 
Figure 1: Hypothesized relationships among variables.......................................... 42 
Figure 2: Observed relationships among variables after data analysis……………. 67 
 
 
 
 
 
 
 
 
 
 
 
 
  
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LIST OF TABLES 
Table 1: Demographic characteristics of participants………………………..….… 47 
 
Table 2: Means, Standard deviations and Cronbach alpha of Variables………..…. 56 
Table 3: Correlation matrix of the relationship among variables…………………. 57 
Table 4: Summary of means and MANOVA results of the influence of social                
negativity on mental health outcomes………………………………...… 59 
Table 5: Hierarchical multiple regression analysis of the moderation effect of                       
history of mental illness on the relationship between religiosity,                             
social negativity and mental health………………………………..……. 61 
Table 6: Hierarchical multiple regression analysis of the moderation effect of                               
stress on the relationship between religiosity and mental health……….. 62 
Table 7: Hierarchical multiple regression analysis of the moderation effect of                           
stress on the relationship between social negativity and mental 
health……………………………………………………………………. 63 
Table 8: Multiple regression analysis of the contribution of levels of education                               
to mental health…………………………………………………………. 64 
 
 
 
 
 
 
 
 
 
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LIST OF ABBREVIATIONS 
AMA          Accra Metropolitan Assembly 
APA         American Psychiatric Association 
DSM           Diagnostic and Statistical Manual of mental disorders 
REL            Religiosity 
SN            Social negativity 
WHO  World Health Organization 
WHO, ICPE  World Health Organization, International Consortium Psychiatric 
Epidemiology 
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CHAPTER ONE 
INTRODUCTION 
1.1 Background to the Study 
Mental health is clearly an integral part of our daily living and well-being as human beings 
(WHO, 2003). The World Health Organization defines mental health as “a state of well-
being in which every individual reaches his/her potential, can cope with the normal 
stresses of life, can work productively and fruitfully, and is able to contribute to his/her 
community” (WHO, 2003 p.7). Mental health goes beyond the absence of mental illness, 
and can be best understood as a complete state which comprises of the presence and 
absence of mental illness and symptoms such as subjective well-being, symptoms of 
positive feelings and positive functioning in life (Keyes, 2002). It is also worthy of note 
that, mental health and mental illness are not opposite sides of a single measurement scale, 
but they have been found as negatively and moderately correlated (Ryff & Keyes, 1995). 
This means that the presence of mental illness does not imply the absence of mental 
health. However, most researches investigating mental health often neglect this fact and 
focus on the presence or absence of mental illness as the conceptualization of mental 
health. 
Mental health is found to have various outcomes on the daily living of individuals and 
communities, thus improving mental health should be the goal of every individual and 
community (WHO, 2009). These mental health outcomes include; healthier lifestyles, 
better physical health, higher educational attainment, greater productivity, improved 
quality of life, among other aspects of well-being (WHO, 2009). Conversely, the 
consequences of poor mental health consist of poor physical health, reduced quality of life, 
fewer employment opportunities, lower productivity at the individual level and it can also 
contribute to violence, drug trafficking, child abuse, paedophilia, suicide, crime and other 
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social vices (Fournier, 2011; Osei, 2008). Promoting the mental health of populations is as 
a result becoming a pertinent tool for achieving strategic goals in health, education, 
sustainable development, employment, culture, sport, crime reduction, community 
cohesion and other aspects of nation building (WHO, 2009). Many countries are now 
acknowledging the significance of focusing on mental health activities which are capable 
of improving the well-being of the whole populace (WHO, 2009). Nonetheless, African 
countries are yet to wake up to this reality. Mental health issues are still not being treated 
with the sense of urgency they deserve (Fournier, 2011). 
Statistics on the size of the global burden of mental illness shows a major and increasing 
public health problem (Murray & Lopez, 1996) and in Ghana, nine percent (9%) of the 
disease burden represents mental illness, with women being affected more by common 
mental disorders than their male counterparts (de Menil, Osei, Douptcheva, Hill, Yaro & 
De-Graft Aikins, 2012). Yet women are underrepresented in treatment settings (de Menil 
et al., 2012). This is because women‟s mental health issues in Ghana are given less 
attention (Ofori-Atta, Cooper, Akpalu, Osei, Doku et al., 2010). Mental illness is linked 
with a considerable burden of morbidity and disability (WHO, ICPE, 2000). The alarming 
part is that the World Health Organization estimates that the lifetime prevalence rate for 
mental, behavioral, and neurological disorders such as schizophrenia, mental retardation, 
alcohol and drug abuse, dementias, stress-related disorders, and epilepsy is 25%; mostly 
affecting the poor, and people from developing countries (Asare, 2003; Fournier, 2011; 
Prince, Patel, Saxena, Maj, Maselko, et al., 2007; WHO, 2002; 2007).  
Gender is considered a very important determinant of health, including mental health 
(WHO, 2000). It is said to control the power and control men and women have over their 
mental health correlates, which include socioeconomic position, roles, rank and social 
status, access to resources and treatment in society (WHO, 2000). Therefore, gender is 
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pertinent in defining vulnerability and exposure to a number of mental health risks (WHO, 
2000). Even though women‟s sexual and reproductive health needs are generally well 
known, there are other important health challenges such as mental illness, which seem to 
be ignored. Usually, women are found to report lower levels of well-being than men 
(Piccinelli & Wilkinson, 2000) and women are more at risk for common mental disorders 
such as anxiety, depression and somatoform disorders (de Menil et al., 2012; Ofori-Atta et 
al., 2010) . Focusing on the mental health of women is therefore not out of place, since 
they seem to be the most vulnerable group to psychological distress. According to the 
WHO, (2000), it has become crucial for deliberations and investigations concerning the 
poor mental health of women to go beyond the focus on individual and “lifestyle” risk 
factors to recognize the wider economic, legal and environmental factors that affect their 
lives.  
Mental health has been attributed to a variety of biological, psychological and socio-
economic factors. Contrary to suggestions in the past that mental health is primarily 
determined by biological and psychological factors, social and demographic factors are 
increasingly being found to have very potent influences on mental health (Harpham, 
Snoxell, Grant & Rodriguez, 2005; WHO, 2000). For instance, results from a study done 
on Ghanaian women in certain selected communities in Accra suggested the correlates of 
physical and mental health in this population as education, income, number of children 
and unemployment (de Menil, et al., 2012). In addition, a World Health Organization 
study of seven other countries found higher depression and anxiety disorder rates in the 
lowest income and education groups within those societies (WHO, ICPE, 2000). Social 
factors that influence physical and mental health include; religiosity, social support, 
marriage, income/financial status, age, education, employment status, and gender (Ellison, 
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Finch, Ryan & Salinas, 2009; Lyons & Yilmazer, 2005; Mirowsky & Ross, 1992; Suhail 
& Chaudhry, 2004). 
From the above, there is the need for continuous research to investigate these social and 
demographic factors, in order to discover the various ways in which they influence mental 
health. Even though studies are being done in this respect, there is still more to be 
investigated especially in Ghana, where there is a paucity of data in this regard. The 
present study has therefore joined the quest to investigate the influence of religiosity, 
social support, and social negativity as well as other demographic variables (such as age, 
income, educational level) on the mental health of women, with a focus on women in 
Accra. 
Religiosity has been defined as “the awareness of the existence of some ultimate supreme 
being who is the origin and sustainer of this universe and the establishment of constant ties 
with this being” (Gyekye, 1996 p.3). The African is considered as living in a religious 
world since the behaviors and thoughts of Africans mostly have religious influences. The 
African culture is infused with religion to the extent that one cannot talk about culture in 
Africa without the mention of religion. According to Gyekye (1996), religious faith among 
Africans is considered as functional and practical rather than as a means for spiritual 
growth or the unification of the human soul with God. “The prayers of Africans are mostly 
requests for material well-being and earthly blessings …Petition for healing and longevity 
is one of the most important and common subjects of prayer because of the African‟s love 
for life” (Gyekye, 1996 p.16). The question then is how this functional and practical use of 
religious faith is employed in relation to mental health among Ghanaians. 
For several years in the past, the psychological/psychiatric community has been wary of 
religion. Religion was either openly opposed or treated with indifference (Wulff, 1997). 
However, the relationship between psychology and religion has become more peaceful in 
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recent times. The DSM-IV of the American Psychiatric Association (APA, 1994) 
recognizes “religious and spiritual difficulties as distinct mental disorder deserving 
treatment” (Sleek, 1994 p.8) which is contrary to the third edition (DSM-III; APA, 1980) 
whereby experiences common to many religions were treated with contempt and explained 
in the light of psychopathology (Kilbourne & Richardson, 1984). Even Ellis who once 
considered religion as irrational, now recognizes that religious beliefs may be helpful to 
some clients (Ellis, 2000). This implies that according to Ellis, religion and spirituality 
may serve as possible effective tools in psychotherapy. 
Since this turn of events, the psychology of religion has been interested in establishing and 
discussing the relationship between religiosity and mental health. Several researchers have 
found positive associations between religion and mental health (Ellison, 1991; Ellison, et 
al., 2009; Rosmarin, Pargament & Mahoney, 2009). Stronger religious identities have 
been found to be linked to greater abilities to cope with stressful situations, greater self-
esteem and overall happiness in addition to improved physical health. Religious coping 
has been found to be associated with a sense of control over difficult situations, leading to 
more positive health outcomes (Pargament, Ensing, Falgout, Olsen, Reilly et al., 1990). It 
is very clear at this point that the importance of religiosity in mental health research cannot 
be overemphasized. 
Apart from religiosity, Africans like other collectivist cultures place so much emphasis on 
social relationships. Most African cultural values can be said to revolve around social 
relationships. For instance humanity, brotherhood and communalism are important 
African cultural values (Gyekye, 1996) which are reflected in some social structures such 
as clan, the extended family and other multifaceted networks of social relationships 
(Belgrave & Allison 2010). Human interaction or exchange targeted towards the well-
being of the individual is very important to Africans. This is expressed in maxims such as 
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“it is the human being that is needed” and “it is the human being that counts; I call upon 
gold, it answers not; I call upon cloth, it answers not; it is the human being that counts” 
(Gyekye, 1996; p. 25).  Despite the fact that Africans hold certain individual values such 
as personal will and personal identity, certain communal values like sharing, mutual aid, 
caring for others, interdependence, solidarity, reciprocal obligation and social harmony, 
are very much emphasized (Gyekye, 1996). Individuals are socialized to think about 
themselves in relation to their relatives (both nuclear and extended family members) and 
they are responsible to seek the well-being and harmony of the family (Belgrave & 
Allison, 2010). This means that each member of the family is expected to provide and 
receive some sort of support, and this goes a long way to reiterate the importance of social 
relations in the African society. 
It is however noteworthy that, social relationships have both positive and negative sides. 
The positive side is what has been conceptualized mostly as social support while the 
negative aspect has been conceptualized as social negativity (Bertera, 2005). Social 
support has been defined as “information from others that one is loved and cared for, 
esteemed and valued, and part of a network of communication and mutual obligations” 
(Taylor, 2009 p. 187). It is a multidimensional construct which can be conceptualized in 
many ways (Bertera, 2005 p. 34). It can be enacted, that is in situations where what is 
measured is actually what people receive, or it can be perceived, and thus in situations 
where personal perceptions of availability of support are measured (Bertera, 2005; Buunk 
& Hoorens, 1992; Finch, 1998). In the present research, social support is conceptualized as 
perceived care and support from family, friends and significant others. Perceived social 
support is employed because of its distinct cognitive component, and it has been found to 
be more important for mental health than received social support (Turner & Marino, 1994; 
Wethington & Kessler, 1986).  
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Social support is one of the most important constructs that have been found to predict 
health outcomes and quality of life in an array of diseases (Hogan, Linden & Najarian, 
2002; Uchino, Cacioppo, & Kiecolt-Glaser, 1996). Barker & Pistrang, (2002) even liken 
social support to psychotherapy and describes it as an “informal” equivalence of 
psychotherapy. Researchers however often bemoan the scarcity of convincing evidence on 
how social support actually influences health outcomes (Hogan, et al., 2002). Moreover, 
research in the past had focused on the beneficial aspects of social relationships (Finch, 
1998). There is recent evidence however that negative socio-emotional interactions and 
interpersonal stress also affect mental health (Bertera, 2005; Reinhardt, 2001a).  
Social negativity in relationships has been linked to physical and mental health indicators, 
including depression (Finch, Okun, Pool, & Ruehlman, 1999). Social negativity has been 
conceptualized as non acceptance, debasement, and lack of affection, understanding, and 
empathy (Rook, 1984). It has also been conceptualized as social conflict, defined by the 
number of network members that sometimes make one angry or upset (Reinhardt, 2001b). 
Research in recent times supports the importance of jointly assessing both positive and 
negative influences of social interactions to enable understanding of the full range of ways 
in which social relationships can affect mental health (Barbee, Derlega, Sherburne, & 
Grimshaw, 1998; Wethington, McLeod, & Kessler, 1987). 
 
1.2Statement of the Problem 
Even though women are reported as being vulnerable to common mental disorders (Belle 
& Doucet, 2003; Patel, Araya, de Lima, Ludermir & Todd, 1999), their mental health 
issues have not received enough attention in Ghana. Health research on women in Ghana 
has focused primarily on physical and reproductive health, neglecting mental health 
(Ofori-Atta, et al., 2010). Major depression is predicted to be the second leading cause of 
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global disease burden by 2020 (Murray & Lopez, 1996). It is obvious that any significant 
reduction in the overrepresentation of women who are depressed would make a significant 
contribution in reducing the global burden of disease and disability. The ability to identify 
and modify social factors that influence women‟s mental health is a possible step towards 
primary prevention of certain mental disorders as well as enhancing the possibility of 
recovery from an already existing one (WHO, 2000). There is therefore the need for a 
paradigm shift in health research among women in Ghana. 
Also, the parliament of Ghana in March 2012 passed the mental health bill into law, which 
was expected to take effect in December 2012. There are however bound to be challenges 
in implementing this law considering the inadequate human and infrastructural resources 
that the mental health sector huddles with currently. The only three public Psychiatric 
hospitals in the country are overburdened with patients, with very few personnel to attend 
to them (Fournier, 2011). It is not surprising therefore that there is no sign of the 
implementation of the law till now. Experts and stakeholders in Ghana are increasingly 
coming to a consensus that the best approach to mental health is community-based 
intervention, in terms of mental health promotion, prevention and treatment of mental 
illness (Akpalu, Lund, Doku, Ofori-Atta, Osei, et al., 2010; Bhana, Petersen, Baillie, 
Flisher & Consortium TMRP, 2010). A community-based approach to mental health 
requires information on the holistic picture of mental health, including finding out some of 
the social, cultural, demographic and economic factors affecting mental health at the 
community level. This is because the effectiveness of any community-based intervention 
would to a large extent be determined by how these factors are controlled. 
There is evidence linking some aspects of religiosity to a variety of positive mental health 
outcomes which include higher levels of psychological well-being (Ellison, 1991; Levin, 
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Chatters & Taylor, 1995). In addition, religiosity and spirituality have been considered as 
very important to individuals who are suffering in one way or the other and/or ill 
(Mathews, McCullough, Larson, Koenig, Swyers et al., 1998; McCullough, Hoyt, Larson, 
Koenig & Thoresen, 2000). Despite this, mental health professionals have either neglected 
religiosity as irrelevant or opposed it as evidence of a different psychopathology 
(Pargament & Brant, 1998; Sims, 1994). Even though the DSM-IV (APA, 1994) 
acknowledges religious and spiritual difficulties as a separate disorder, Psychiatry and 
Psychology still seem to have no formal place for it in the management of mental 
disorders. 
In addition, African culture emphasizes the importance of social support. Individuals in 
the society are therefore expected to express concern for the well-being of others (Gyekye, 
1996). However this culture of communalism may not be extended to people living with 
mental illness, considering the fact that stigma against these individuals is high. Despite 
the fact that people‟s understanding of mental illness has been improving, stereotypes of 
dangerousness and the wish for social distance towards the mentally ill has still not 
changed much (Link &Phelan, 1999). People with mental illness have been reported to 
perceive less social support compared to people without mental illness (Cecil, Stanley, 
Carrion & Swann 1995; Kitamura & Takahashi, 1999; Torgrud, Walker, Murray, Cox, 
Chartier et al., 2004).Further, due to urbanization and the infiltration of western culture, 
“communal living” previously thought to be characteristic of Africans is losing its 
grounds, especially in the urban areas; next door neighbours even do not know each 
other‟s names let alone be concerned about their well-being. The question about how the 
change in social relations is affecting mental health has thus become pertinent. It has also 
been indicated that women who often report more social resources than men consistently 
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report more psychological distress than men (Schuster, Kessler & Aseltine, 1990). Is it 
because they perceive more negative interactions than support? 
Despite the importance of religiosity and social relationships on mental health, there is a 
dearth of research with regards to women. Research is needed to find out how these 
aspects of the African culture and society (religiosity & social relationships) affect the 
mental health of women. 
 
 
1.3Aims and Objectives of the Study 
The present study seeks to find out how religiosity, social support, social negativity and 
selected demographic variables influence the mental health of women in Accra. More 
specifically, the study is guided by the following objectives: 
1. To find out whether religiosity has a significant influence on mental health 
among women in Accra and the direction and nature of the association. 
2. To find out whether social support and social negativity have significant 
influence on the mental health of women and to ascertain the dynamics of 
this association. 
3. To find out whether religiosity, social support and social negativity have 
the same or similar effects on women with mental illness as those who do 
not have any history of mental illness. 
4. To find out whether the relationship between religiosity, social support, 
social negativity and mental health is influenced by perceived stress. 
5. To find out how women‟s demographic characteristics influence their 
mental health  
 
 
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1.4 Relevance of the Study 
As acknowledged by Ofori-Atta et al., (2010), women‟s mental health issues have been 
neglected; the focus on women is therefore one thing that sets this study apart from the 
others, in the sense that it provides empirical information on some determinants of mental 
health among women in Accra which will go a long way to inform decisions on 
community-based interventions in the prevention and treatment of mental illness amongst 
women. The use of both clinical and community-based samples is also a peculiar feature 
of the present research; which allows for comparisons and enhances the ability to make 
generalizations in both groups.  
In addition, knowledge about the effects of religiosity, and social relationships would help 
in making predictions about women‟s mental health as well as prognosis in treatment and 
management planning. The study would also set the pace for more research in this area of 
women‟s health in Ghana as well as add to existing literature in the area of mental health.  
  
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CHAPTER TWO 
LITERATURE REVIEW 
2.1 Introduction 
This study seeks to find out how religiosity, social support, social negativity and selected 
demographic variables influence the mental health of women in Accra. In this chapter, the 
researcher discusses relevant theories that seek to explain the relationship between 
religiosity, social relationships and mental health. This chapter also contains review of 
related studies, rationale for the study, statement of hypotheses, hypothesized conceptual 
framework and operational definition of terms. 
 
2.2 Theoretical Framework 
Quite a number of empirical studies have been carried out to investigate the relationship 
between religiosity and various aspects of mental health, including psychological well-
being, depression, anxiety, quality of life and subjective well-being. Most of these studies 
have found statistically significant but low positive relationship between religiosity and 
various dimensions of mental health (Beit-Hallahmi & Argyle, 1997; Laurencelle, Abell & 
Schwartz, 2002).  How is this relationship explained? Developing or identifying models 
and theories that explain and interpret findings on religion and mental health is very 
crucial in understanding this phenomenon. Some authors and researchers have used 
different theories and models in explaining this relationship, some of which are explained 
as follows: 
 
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2.2.1 Stressor Reduction/Prevention Model (Ellison, 1994; Grasmick, Bursik & 
Cochran, 1991) 
One theory which has been suggested by researchers to explain the relationship between 
religiosity and mental health is the Stressor reduction or prevention model, which states 
that religious participation and belief may lead to better mental health by reducing the 
levels of/exposure to stressors by influencing the individual‟s behavior and lifestyle 
(Ellison, 1994; Grasmick et al., 1991).This may include avoidance of negative health 
behaviors such as substance abuse, and encouragement of moderation in all things, thereby 
reducing the likelihood of other forms of risk-taking behaviors such as gambling and 
irregular sleep patterns. Religion has also been found to be associated with lower rates of 
certain life stressors such as marital distress, divorce, conflict and other family problems, 
in so doing reducing their various negative mental health outcomes (Call & Heaton, 1997; 
Pearce & Axim, 1998). This suggests that, people who are highly religious experience less 
stressful life events and in turn have better mental health than the less religious. 
However, examining this model, one question that comes to mind is whether religion does 
not influence the mental health of those who are already experiencing major stressful 
events or conditions such as physical/mental illness, as the model seems to be emphasizing 
the prophylactic role of religiosity on stress. If stress already exists in the individual‟s life, 
what role does religion play?  People with both physical and mental illness experience so 
much stress associated with their conditions. A critique of this model seems to raise 
questions about the protective effects of religion on the mental health of people suffering 
from mental illness. 
 
 
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2.2.2 Religious Coping Theory (Pargament, 1997) 
The religious coping theory seems to address the question posed by the stressor 
reduction/prevention model. The theory states that people draw on religious beliefs and 
practices to understand and deal with life stressors and this in turn influences their mental 
health in many ways. Certain religious beliefs such as the belief that “God is directing 
one‟s path” and that “He gives His children strength to overcome challenges” as well as 
“making all things work together for their good” are also indicated to strengthen an 
individual‟s sense of control over life events and situations (Smith, 2003), this 
consequently helps reduce psychological distress since sense of control has been found to 
reduce psychological distress (Keeton, Perry-Jenkins & Sayer, 2008).Religion is also said 
to provide an optimistic worldview which involves a supernatural force (e.g. God) who is 
considered as loving and caring about humans and controls all things which also in turn 
increases a person‟s sense of control, provides answers to existential questions such as 
“where do we come from?” and “where are we going?” (Koenig, 2012, Smith, 2003) 
hence negative life events become less distressing for religious persons, and this may 
translate into positive mental health outcomes. Joon Jang and Johnson (2004) in their 
study found that African Americans who were highly religious had more sense of control 
and social support and this led to a reduction in psychological distress compared to their 
less religious and non-religious counterparts.  
According to Pargament (1997), religious coping can be positive or negative. The question 
then is how do women in Accra draw on their religious beliefs and practices to deal with 
stressors; are they more likely to use positive strategies or negative ones? Does this have 
beneficial or harmful effects on their mental health?  
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2.2.3 Stress and Coping Perspective (Lakey & Cohen, 2000) 
Stress and coping perspective was developed based on the stress response model 
postulated by Lazarus, 1966; Lazarus & Folkman, 1984.  According to this model, an 
individual‟s response to stress occurs in three stages; a person first of all determines if the 
event is a threat or not (primary appraisal) , followed by an evaluation of the coping 
resources available (secondary appraisal) and a continuous re-evaluation and changing of 
primary and secondary appraisals (reappraisal), thus stress only occurs when the person 
perceives the situation as a threat and/or perceives an unavailability of adequate coping 
resources which then can lead to negative physiological or health problems (Lakey & 
Cohen, 2000). 
Based on the above premise, the stress and coping perspective suggests that social support 
is one of the coping resources of stress and therefore reduces the effects of stressful life 
events on health through either supportive actions of others or the belief that support is 
available (Lakey & Cohen, 2000).Supportive actions of others are found to enhance an 
individual‟s coping ability while perceptions of available support may lead to evaluating 
potentially threatening situations as less stressful (Lazarus, 1966; Lazarus & Folkman 
1984). This implies that individuals going through major life stressors such as illness, who 
perceive that social support is available would interpret their situations as less stressful. 
This enhances the individual‟s capacity to cope with the situation and in turn has 
beneficial effects on both physical and psychological well-being (Kawachi & Berkman, 
2001).  
Remarkable efforts have been made to establish the beneficial effects of social 
relationships on health and well-being. Research has established that persons with more 
types of social relationships live longer and have less cognitive decline with aging, greater 
resistance to infectious disease and better prognosis in the face of chronic and life-
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threatening illness (Cohen & Janicki-Deverts, 2009). Most research that have been 
conducted on stressful events and coping have also indicated that one of the most effective 
means by which individuals cope with stressful events is through social support, and social 
support is indicated to serve as a protective factor against psychological distress that is 
likely to result from those stressful events (Lowe, Chan & Rhodes, 2010; Pickens, Field, 
Prodromidis, Pelaez-Nogueras & Hossain, 1995).  
2.2.4 Social Exchange Theory and the Expectancy Theory (Bengtson & Dowd, 1980; 
Olson, Roese, and Zanna 1996) 
Most of the theories and models linking social relationships with mental health seem to 
overlook the fact that social relationships are not always positive and may sometimes in 
themselves be stressful to the individual. There is a need for theories on social 
relationships to look at both positive (social support) and negative (social negativity) sides 
of social relationships (Bertera, 2005). The Social exchange theory provides insights and 
predictions on how relationships among family, friends and significant others may 
influence various mental health outcomes (Bertera, 2005; Robbins, Chatterjee, & Canda, 
1998).  
The social exchange theory suggests that social interaction tends to be motivated by a 
desire to maximize benefits and reduce costs by seeking rewarding exchanges and 
avoiding unpleasant ones (Bengtson & Dowd, 1980). This implies that social exchanges 
that are perceived to be positive would lead to positive mental health outcomes while ones 
that are perceived to be negative would lead to negative mental health outcomes (Bertera, 
2005). This is consistent with the expectancy theory which posits that individuals expect 
relationships with friends and family to be caring or supportive hence interpersonal 
unpleasantness violates this expectation (Olson, Roese, and Zanna 1996). Accordingly, 
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any noticeable negative interaction is likely to be perceived as a behavior which deviates 
from the norm, so when it arises, it often surprises the recipient and threatens his/her sense 
of meaning, predictability, and order, which may lead to severe mental health 
consequences (Zhang, 2012).  
To conclude, the theories most pertinent to the present study are the religious coping 
theory, the social exchange theory and the expectancy theory.  
Aside other personal and environmental resources that individuals rely on to cope with life 
events and situations, religion provides additional resources through its beliefs and 
practices which enhance a religious person‟s ability to cope with situations. Consequently, 
the enhanced mastery over life events and situations translates into one‟s mental health. A 
highly religious person is therefore more likely to draw more on these religious coping 
resources than a less religious person leading to a better mental health in the highly 
religious persons compared to the less religious persons. 
Even though social relationships have been considered as generally beneficial, the social 
exchange theory points to the fact that there is also a dark side to social relationships, 
hence there are both beneficial and deleterious effects. Since individuals expect 
interactions with relatives/spouse, friends and significant others to be pleasant, the 
perception of a supportive relationship with them is likely to have positive effects on their 
mental health while the perception of frequent negative interactions is likely to have 
negative effects on their mental health (since this defies their expectations of the 
relationship). Looking at the Ghanaian culture, the effects of negative interactions may 
even be greater since humanity, brotherhood and communalism are said to be valued so 
much (Gyekye, 1996). 
  
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2.3 Review of Related Studies 
Review of related studies has been divided into three main sub-headings, comprising of 
religiosity and mental health, social relationships and mental health and demographic 
variables and mental health. These main sub-headings are further divided into other 
categories. 
2.3.1 Religiosity and Mental Health 
Interest in the complex relationships between religiosity and mental health has deep roots 
in the social and behavioral sciences, dating back to the works of Freud, James, Jung, and 
many other classic thinkers (Ellison, et al., 2009). It is therefore not surprising that there 
has been a dramatic increase in psychological research in this area. The influence of 
religiosity on mental health has been studied using variety of mental health outcomes 
among various populations. Some of these mental health outcomes found in the literature 
are discussed as follows: 
 
Religiosity, psychopathology and well-being 
Studies have consistently demonstrated that religiosity is significantly tied to anxiety, 
depression, and subjective well-being in various populations. For instance, in a study 
carried out by Abdel-Khalek (2009) who explored the associations between religiosity and 
both subjective well-being and depression, among Saudi school children and adolescents, 
it was found out that females obtained a significantly higher mean score on depression 
than their male counterparts which confirms the assertion that females are more vulnerable 
to depression (Belle & Doucet, 2003) and that females report lower levels of well-being 
than men (Piccinelli & Wilkinson, 2000). All the correlations were significant between 
religiosity and both subjective well-being rating scales (positive) and depression 
(negative) irrespective of gender.  The researcher concluded that religious persons (in this 
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sample) were happier, healthier, and less depressed. However, as accepted by the 
researcher, even though a large sample size has been employed in this study, it is crucial to 
make conclusions about this research in the light that its findings are limited to this group 
(11-18 year old Saudi school children). To be able to generalize the findings, there is a 
need to expand the age range to adulthood in order to ascertain its generalizability to 
adults.  
The researcher, (Abdel-Khalek, 2011) conducted another study in which he explored the 
association between religiosity, subjective well-being, self-esteem, and anxiety among a 
sample of 499 Muslim Kuwaiti adolescents. Results suggest that religiosity is associated 
with high levels of self-rating of subjective well-being, self-esteem and low levels of 
anxiety. 
This provides further evidence that religiosity has positive influence on various aspects of 
mental health, since positive relationship has been found with positive mental health 
outcomes (subjective well-being and self-esteem) and negative relationship with negative 
mental health outcomes (depression and anxiety) in these two studies carried out in a very 
large sample and a much smaller sample size by the same investigator .The caveat 
however is that these studies have been carried out on participants with the same religious 
affiliation (Islam) which brings to mind the question of whether the same results will be 
obtained when participants belong to diverse religions. 
 
To compare the psychopathology between depressed patients with low religiosity and 
those with high religiosity and to correlate the level of religiosity with their 
psychopathology in the psychiatric clinic of a general hospital in Chandigarh (North 
India), Gupta, Avasthi and Kumar (2011) studied 30 depressed patients with low 
religiosity and 30 patients with high religiosity. In these patients, hopelessness and 
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suicidal intent correlated negatively with their level of religiosity, meaning those who 
were high on religiosity were less hopeless and suicidal which points to the buffering 
effects of religiosity on negative mental health outcomes/ psychopathology. A strong point 
for this particular research is that it measures religiosity with a scale that is not specific to 
any religion but measures level of religious faith and belief, and consequently can be used 
for all religious groups. Nonetheless, replicating the study using a community-based 
sample would improve its generalizability and contribution to the literature since only 
clinical samples were used in this study. 
Research on the influence of religiosity on mental health is not only restricted to 
depression and anxiety but also implicated in other forms of psychopathology such as 
bipolar disorder. An example is a cross-sectional study of follow-up data from a study of 
patients receiving care for bipolar disorder at an urban Veterans Affairs mental health 
clinic. This research was conducted by Cruz, Pincus, Welsh, Greenwald, Lasky et al., 
(2010). The researchers investigated the association between various dimensions of 
religiosity (frequency of church attendance, frequency of prayer or meditation, as well as 
influence of beliefs on life) and mixed, manic, depressed, and euthymic states after 
controlling for demographic variables, anxiety, alcohol abuse, and health indicators. 
Multivariate analyses found significant associations between higher rates of prayer or 
meditation and mixed state as well as lower rates of prayer ⁄ meditation and euthymia.  
Contrary to earlier findings, depression and mania had no significant associations with 
religious attendance. This lends credence to criticisms that the use of organizational 
religion (such as religious involvement or attendance) in measuring religiosity is not 
reliable (Flannelly, Ellison, & Strock, 2004; Hall, Meador & Koenig, 2008).There is also 
an indication from this particular study that certain religious activities such as prayer may 
actually have positive relationship with certain aspects of psychopathology. Unfortunately, 
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these researchers failed to control for stress which could have influenced the results of this 
study since there is some evidence suggesting that people who are going through some 
form of stress are more likely to be involved in religious activities such as prayer and 
rituals than those who are not (Ellison & Levin, 1998).  
There is also a great body of literature which demonstrates salutary effects of religious 
beliefs and spirituality on psychological well-being (Joshi, Kumari & Jain, 2008). The 
majority of studies conducted since the year 2000 as reviewed by Moreira-Almeida, 
Lotufo Neto and Koenig, (2006) found that higher levels of religious involvement are 
positively associated with indicators of psychological well-being (life satisfaction, 
happiness, positive affect, and higher morale) and with less depression, suicidal thoughts 
and behavior, drug/alcohol use/abuse. Usually the salutary effects of religious involvement 
on mental health have been found to be stronger among people under stressful 
circumstances; the elderly, and those with disability and illness, implying that stress 
moderates the relationship between religious involvement and psychological well-being. 
This finding partially supports the religious coping theory which posits that religion 
influences mental health by serving as a coping resource in dealing with stress 
(Pargament, 1997). Using religious involvement as a measure of religiosity in these 
studies reviewed, one would have expected the researchers to control for social ties, since 
it might not be religious involvement in itself that affects psychological well-being but 
supportive social interactions derived from the involvement in religious activities (Ellison 
et al., 2009). 
Religiosity, coping with stress and mental health 
There is also some evidence indicating that religiosity is an effective coping resource not 
only for people with health related problems but also those who have no such problems 
(Plakas, Boudioni, Fouka & Taket, 2011; Trevino, Archambault, Schuster, Richardson & 
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Moye, 2012). In Plakaset al.’s, (2011) study, 25 relatives (mostly first degree relatives) of 
patients in the intensive care units of three public general district hospitals in Athens 
(Greece), participated in 19 interviews. Religiosity was found to be the main source of 
hope, strength and courage for relatives. This was expressed in church/monastery 
attendance, belief in God, praying, and performing religious rituals which in turn 
alleviated negative emotions.  
Also, in a longitudinal study in which Philips (III) and Stein (2007) examined religious 
meaning-making coping in a sample of 48 young adults diagnosed with schizophrenia or 
bipolar disorder over a one-year period. Participants with mental illness generally reported 
using religious meaning-making coping in levels comparable to non-psychiatric samples. 
Participants who reported benevolent religious reappraisals had higher perceptions of 
positive mental health, whereas those who reported punishing God reappraisals and 
reappraisals of God‟s power also reported higher distress and personal loss. Religious 
coping variables accounted for variation in participants‟ reports of psychiatric symptoms 
and personal loss one year later regardless of demographic and global religious variables. 
This again supports the religious coping theory and but demonstrates that religious coping 
may have both positive and negative implications for individuals, depending on its use 
(Pargament, Smith, Koenig, & Perez, 1998). 
In addition, Trevino et al.‟s (2012) study on religious coping and psychological distress 
among military veteran cancer survivors, in which 48 veteran cancer survivors completed 
measures of psychological distress, posttraumatic growth, and positive and negative 
religious coping, it was found out that negative religious coping was associated with 
greater psychological distress and posttraumatic growth. Positive religious coping was also 
associated with greater growth. The researchers suggested that assessment of religious 
coping may be particularly important for female, non-White, and Christian cancer 
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survivor. The researchers suggest that religiosity is a very important coping resource for 
women and people of non-white decent in dealing with illness. The implication of this 
finding for the present study is that religiosity will serve as a coping resource for women 
in Accra, especially those who are dealing with mental illness.  
Furthermore, the association between religiousness and depressive symptoms was 
examined by Smith, McCullough, & Poll (2003) with meta-analytic methods across 147 
independent investigations. The relationship between religiosity and depressive symptoms 
across all the studies that were analyzed revealed that greater religiosity was slightly 
linked to fewer depressive symptoms. These results were not influenced by demographic 
variables (such as, gender, age, or ethnicity). However, the relationship between religiosity 
and depression was stronger in studies relating to individuals undergoing stress due to 
recent life events. This finding further emphasizes the impetus for researchers to consider 
the influence of stress in the relationship between religiosity and mental health since it 
may have the potential of influencing the relationship between religiosity and mental 
health outcomes. 
Despite the fact that most research on religiosity and coping with illness have concentrated 
on physical illness, religiosity could also serve as a good coping resource for people with 
mental illness (Taylor, 2001). Moreover, there is a suggestion that religiosity maybe a very 
important tool for recovering from mental illness. This was confirmed in Webb, 
Charbonneau, McCann and Gayle‟s (2011). study in which eighty-one (81) participants 
with severe mental illness were sampled, participant‟s recovery, religious support, and 
struggle or endurance with faith were measured through self-report measures. Results 
reveal that religious support and enduring with faith were positively correlated with 
recovery while struggle with faith was negatively associated with recovery. This research 
is however limited in terms of its ability to be generalized to other populations since most 
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of the participants used were Caucasians (84 %). Type of mental illness used in this study 
was also restricted to schizophrenia, schizoaffective, bipolar disorder and major 
depression. 
Even though a large body of literature has documented salutary relationships between 
various aspects of religious involvement and mental health outcomes, including depressive 
symptoms, there is a controversy in the literature with regards to which measures of 
religiosity are actually related to mental health outcomes. There is an indication that 
certain dimensions of religiosity may not be strong enough to be able to establish its 
effects on certain aspects of mental health. This explains why some researchers found no 
relationship between certain aspects of religiosity and mental health outcomes (Smith et 
al., 2003).   
For example, in Ellison, et al.‟s (2009) research in which a number of hypotheses 
concerning main and contingent effects of religious attendance, salience, and consolation-
seeking were tested, using data on a large sample of Mexican-origin adults. There was an 
initial negative relationship between religious attendance and depressive symptoms. This 
relationship however disappeared after controlling for supportive social ties. The positive 
association between religious salience and depression on the other hand persisted despite 
all statistical controls; this relationship was present among both men and women, but it 
was significantly stronger for women. 
 It could therefore be concluded based on this study that religious attendance is not strong 
enough to influence depressive symptoms and could only have an influence when 
supportive social ties are present, but religious salience is a stronger measure of religiosity. 
This demonstrates the importance of using reliable and multidimensional measures of 
religiosity in conducting mental health research. 
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In another study carried out by Baker and Cruickshank (2009), the influence of religious 
affiliation, saliency, and practice on levels of depressive symptoms and treatment 
preference was investigated in a sample of Christians, Muslims, Atheists, and Agnostics. 
No significant differences in depressive symptoms were found between affiliations. 
However, saliency and frequency of practice had a weak negative correlation with 
depressive symptoms for Christians, but strangely they were not significant for Muslim 
participants. The researchers attributed the difference between Christians and Muslims to 
the fact that data was collected during the Ramadan period of the Muslims and this could 
confound the measure of saliency and frequency of practice. One thing that remains 
obvious however is the fact that religious affiliation alone is not a strong measure that 
influences depression since there was no difference even between religious groups 
(Christian and Muslim) and non-religious groups (Agnostics and Atheists).  
Rosmarin, Pargament and Mahoney (2009) also investigated the role of Jewish 
religiousness in anxiety, depression, and happiness, in a Jewish community sample (565). 
Several aspects of global Jewish religiousness were examined, as well as a theoretically 
based Jewish religious variable, “trust in God”. A self-report measure of trust in God was 
created, and factor analyses yielded two reliable and valid subscales: trust in God and 
mistrust in God. Contrary to their hypothesis, global Jewish religiousness was on the 
whole unrelated to mental health functioning. On the other hand, higher levels of trust in 
God were associated with less anxiety and depression, and greater personal happiness, 
whereas inverse associations emerged for the mistrust subscale; suggesting global 
religiousness might not be a strong measure of religiosity. 
In addition to the above, a study examining the relationship between religious beliefs, 
anxiety and depression was carried out by Jansen, Motley and Hovey (2010). No 
difference was found between Catholic and other Christian denominations in rates and 
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levels of depression and anxiety. Self-reported religious influence and self-reported 
religiosity were however significantly related to depression but not anxiety. Religious 
service attendance was also negatively correlated with both anxiety and depression. From 
this study, it is clear that religious affiliation had no influence at all on depressive and 
anxiety symptoms but rather religious influence, self-reported religiosity and religious 
attendance did. The obvious flaw of this study is the use of organizational religiosity 
measure (religious attendance) without controlling for religious social support since this 
has been found to moderate the relationship (Ellison et al., 2009; Nooney & Woodrum, 
2002). One can therefore not vouch for the reliability of the finding which claims religious 
service attendance had a negative relationship with depression and anxiety in this sample. 
These studies suggest that certain aspects of religiosity may play a more influential role in 
the protection against psychopathology, indicating that different dimensions of religion 
play different roles in individuals‟ mental health. The dimension of religiosity used in a 
particular study is therefore very essential because it has the potential of influencing the 
findings. It is necessary to use theoretically based and quantifiable measures of religiosity, 
(such as strength of religious faith or religious saliency) in addition to global measures 
such as religious attendance (Green & Elliot, 2010; Rosmarin, et al., 2009). 
 
2.3.2 Social Relationships/Interactions and Mental Health 
There is a rapidly increasing evidence of the importance of social relationships on physical 
and mental health (Cohen & Janick-Deverts, 2009; Umberson & Montez, 2010). As 
mentioned earlier, there are two sides to social relationships; the supportive side and what 
some researchers term as “the dark side” (Bertera, 2005; Umberson & Montez, 2010). 
However, research in the past had focused on the beneficial aspects of social relationships 
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[social support] while very little is known about the negative aspects of social 
relationships [social negativity] (Finch, 1998).  
It has also been established that perceived social support can function as a pain-buffering 
mechanism, promoting increased self-efficacy and optimism as well as reduced loneliness 
in the face of stress. This may in turn protect an individual from mood disorders such as 
depression and anxiety and other forms of mental disorders (Mikulincer & Shaver, 2008; 
Southwick, Vythilingam, & Charney, 2005).Researchers and theorists from diverse 
disciplines have studied the ways in which social relationships can influence individuals‟ 
physical and mental health. Despite the fact that most researchers have come to agree that 
there is an important association between social support and well-being, they continue to 
define and study social support in different ways (Vangelisti, 2009). Some of the 
relationships between positive and negative aspects of social relationships and various 
mental health outcomes found in the literature are discussed as follows: 
 
Positive and negative social exchanges, psychological distress and well-being 
Jasinkaja-Lahti, Liebkind, Jaakkola and Reuter‟s (2006) study on three different 
immigrant groups confirms the influence of both positive and negative sides of social 
relationships on psychological well-being among minority groups in society. These 
researchers conducted the study among three immigrant groups (Finnish repatriates, 
Russian Estonian and citizens from other countries of the former Soviet Union). It was 
found out that Perceived discrimination had a significant influence on psychological well-
being such that, the more the immigrants perceived discrimination, the lower their level of 
psychological well-being. In the total sample, there was a strong evidence of direct and 
buffering effects of host support networks on well-being. In addition, social support 
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provided by ethnic networks abroad was generally beneficial for the psychological well-
being of the immigrants. 
Perceived discrimination in the above study could be likened to perceived social negativity 
which is being studied presently. It is therefore not out of place to suggest that perceived 
social negativity would have similar effects as perceived discrimination in women in 
Accra. However care must be taken in generalizing this finding because as well noted by 
the researchers, these immigrant groups found themselves in a new culture and so 
acculturation played much role in the findings of the study which may not be a case 
among the sample in the present study.  
Also in Vogt‟s (2007) study of age discrimination and mental health, in which adults 25-
74 years were used, results revealed that persons who perceived either age discrimination 
or discrimination due to another reason had higher psychological distress and lower 
positive well-being than persons who had not experienced any discrimination. Sense of 
control and social support were found to buffer the effects of perceived discrimination, 
thus they both were associated with lower psychological distress and higher positive well-
being. Putting social support and perceived discrimination side by side in this study, it will 
not be out of place to conclude that perceived discrimination has deleterious effects on 
mental health while social support has salubrious effects on mental health.  
Perceived age discrimination was also found in the above study to have more negative 
influence on women than men, in that women who perceived age discrimination had 
higher psychological distress and lower positive well-being than men. This indicates that 
the experience of negative social interactions may have greater influence on women than 
men, which explains why women who report more social resource than men seems to 
report more psychological distress than men (Schuster, Kessler & Aseltine, 1990). This is 
consistent with Flett, Hewitt, Garshowitz and Martin‟s (1997) study on personality, 
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negative social interactions, and depressive symptoms among university students, who 
found out that the relationship between negative social interactions and depressive 
symptoms was more robust in women than men. 
In a related study, Whisman (2013) in his investigation of the link between relationship 
discord, prevalence, incidence and treatment of psychopathology found relationship 
discord to be associated with prevalence of psychiatric disorders and predictive of the 
incidence of mood, anxiety, and substance use disorders and increases in depressive 
symptoms. Studies such as this lend credence to the assertion that negative side of social 
relationships has dire consequences on mental health (Finch, 1998).  
Walen and Lachman, (2000) also investigated the association between social support and 
strain on one hand and psychological well-being and physical health on the other. Both 
social support and strain were related to psychological well-being and physical health but 
had more influence on psychological well-being than physical health. Social support was 
however found to have more influence on psychological well-being than strain. 
Unfortunately, these researchers focused on only the positive side of mental health 
(psychological well-being) and not bothering about the negative side (psychological 
distress). Perhaps strain would have been found to have more influence than social support 
if psychological distress measures were used. This stresses the importance of measuring 
both sides of the mental health continuum in order to have a holistic picture of the 
influence of social relationships on mental health outcomes. 
Similarly, Zhang (2012) in his study on negative social exchanges, acculturation-related 
factors, and mental health among Asian Americans measured both positive and negative 
social exchanges, family cultural conflict and psychological distress. Positive social 
exchange was found to be negatively correlated with psychological distress while negative 
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social exchange was positively correlated with psychological distress. Contrary to Walen 
and Lachman‟s (2000) findings, negative social exchange was found to have more 
influence on psychological distress than positive social exchange. The obvious reason for 
these contradictory findings is the fact that the former focused on the positive side of the 
mental health continuum (psychological well-being) while the latter focused on the 
negative side (psychological distress). Even though the investigator attributed the fact 
negative social interactions had more influence on psychological distress than positive 
interactions to the collective culture of the sample used (Zhang, 2012), such conclusions 
may not be valid until a holistic measure of mental health is used. This again reiterate the 
importance of measuring both positive and negative mental health outcomes in order to 
establish the actual influence of both negative and positive aspects of social relationships. 
Again, in Lincoln‟s (2000) review of literature, of the twenty-five (25) studies, nineteen 
(68%) of them reported that negative social interactions had a greater impact on 
psychological well-being than positive interactions while only one of them reported 
positive interactions as having a greater impact than negative interactions. Six of them 
(21%) found both positive and negative interactions reported equal effects. One flaw that 
was however observed in this review is the fact that only nine (32%) out of the 25 of the 
studies used comparable items in measuring positive and negative social interactions. This 
may in part explain the diversity in the findings. The conceptualization and measurement 
of both positive and negative aspects of social interaction is therefore crucial to the 
outcome of every research in this area.  
The above lends credence to Finch et al.‟s (1999) findings. In their literature review, 
perceived social support was found to be the form of positive social interaction that has the 
most effect on mental health outcomes while ratings of the frequency with which negative 
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social behaviors were directed at the target person was the most potent measure of social 
negativity/negative interactions. This assertion however needs to be investigated through 
empirical research, which the present study seeks to do. 
Using the measures of positive and negative social interactions suggested by Finch et al. 
(1999), Bertera (2005) investigated positive social support, social negativity, and anxiety 
and mood disorders in a random sample of adults aged 21–54 years from a National Co-
morbidity Survey (1990–1992). Positive social support and social negativity from three 
sources was measured (spouse, relatives and friends). Social negativity from all three 
sources had positive association with depressive and anxiety symptoms. In line with 
Zhang‟s (2012) finding, positive social support was not found to be as strongly associated 
with depressive and anxiety symptoms as social negativity in that only positive social 
support from relatives was associated with lower symptoms but the other two sources 
(spouse and friends) were not. However, just like the others, this study used negative 
mental health outcomes only (anxiety and depression). That notwithstanding, the findings 
confirm that both positive and negative interactions are associated with mental health 
outcomes. Another interesting indication from this study is that the source of positive 
interactions is very important and needs to be considered in studying the relationship 
between social relationship and mental health just as it is important to consider both 
positive and negative mental health outcomes.  
Social relationships, stress and mental health 
Even though studies have consistently demonstrated that both positive and negative social 
interactions influence mental health outcomes significantly, it has also been suggested that 
this relationship is moderated by stressful life events. Unfortunately, many of the studies 
done on the effects of social relationships on stress and mental health had focused 
primarily on social support. Most of these studies were also done among subgroups who 
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are considered to be experiencing some stressful life events such as victims of natural 
disaster, bereaved and divorced individuals, people living with serious illnesses and their 
caregivers, pregnant women among others (Israel, Farquhar, Schulz, James & Parker, 
2002; Kim, Han, Shaw, Mctavish & Gustafson, 2010; Lowe, Chan & Rhodes, 2010).  
One of the few studies which examined the moderating effects of stress on the relationship 
between both positive and negative social exchanges on mental health is that of Ingersoll-
Dayton, Morgan and Antonucci (1997) who studied a probability sample of men and 
women aged fifty to ninety-five. Participants reported on positive and negative exchanges, 
positive and negative aspects of well-being (positive and negative affect) and the number 
of stressful life events experienced within the past five years (including death of spouse, 
illness or injury, being fired and several other life events) through structured interviews 
carried out in the homes of the participants. As expected, positive aspects of social 
exchanges were related to positive aspects of well-being (positive affect), and negative 
aspects of social exchanges were related to negative aspects of well-being (negative 
affect). In addition, the relationship between negative exchanges and negative affect was 
stronger for participants who experienced multiple life events while the influence of 
positive exchanges on positive affect was stronger for those who experienced few life 
events.  
This suggests that stressful life events play a crucial role in the relationship between social 
interaction and well-being, in that stress strengthens the negative effects of negative 
interactions while it weakens the positive effects of positive interactions. One must 
however be mindful of the fact that this study focused on the aged (50-95 years) who are 
already saddled with age-related stressors and so might be limited in scope in terms of 
generalization. There is a need to extend the scope of the study to include younger adults 
in order to make confident claims or conclusions about the moderating effects of stress. 
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Lowe et al.‟s (2010) study focused on the protection of pre-hurricane perceived social 
support against psychological distress in a longitudinal analysis of low-income mothers. 
Three hundred and eighty-four low-income mothers with baseline age of between 18 and 
34 who were enrolled in an educational intervention study were used for this study. 
Participants who completed a one year follow-up assessment preceding Hurricane Katrina 
were reassessed one year after the hurricane. The pre- and post- disaster assessments 
included perceived social support and psychological distress. The analysis revealed that 
both pre- and post- perceived social support predicted psychological distress in both 
instances. Perceived social support during pre-disaster assessment decreased during the 
post-disaster assessment, consequently, psychological distress also increased during post-
disaster assessment.  
The above findings suggest that the experience of major stressors can actually reduce a 
person‟s perception of available support. This conclusion can only be reached nonetheless 
if similar findings emerge in comparative studies and studies that employ other forms of 
stressors than stressors related to a natural disaster. One important finding in this study 
however is that, although pre-disaster perceived social support was found to have no direct 
influence on post-disaster psychological distress, it predicted the number of hurricane-
related stressors, perceived support after the hurricane and both pre- and post hurricane 
psychological distress, that is participants who perceived greater pre-disaster social 
support had less pre-disaster psychological distress, experienced fewer hurricane-related 
stressors, and perceived more support in the aftermath of the hurricane which in turn were 
associated with less post-disaster psychological distress. It would not be out of order then 
to suggest that perceived social support is preventive of stress and in turn protects a person 
against the deleterious effects of stress, and indicative of a mediating effect of stress on the 
relationship between social support and psychological distress. It could further be argued 
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that those who experienced fewer hurricane-related stressors perceived higher levels of 
social support and hence had less psychological distress and vice versa, since generally, 
perceived social support decreased after the disaster. 
The above argument is confirmed by Lincoln, Chatters and Taylor‟s (2005) study. These 
researchers investigated the effects of social support, and traumatic events on depressive 
symptoms among African American men and women aged between 18 and 54 years. 
Measures employed include; measures of depressive symptoms, financial strain, traumatic 
events, social support and negative interactions. Findings indicate that participants who 
reported more financial strain (which is a stressor) reported less social support and more 
negative interactions and consequently reported more depressive symptoms. As expected, 
those who reported more traumatic events also reported more depressive symptoms. One 
interesting result from this finding is that, even though women reported fewer traumatic 
events as compared to men, they reported more negative interactions and more depressive 
symptoms. It is suggestive of the fact that women generally perceive more negative 
interactions than support from their social resources and explains why women who report 
more social resources than men also report more psychological distress (Schuster et al., 
1990). The surprising finding in this study however is that, negative interaction was found 
to have no significant effects on depressive symptoms whereas social support was found to 
be associated with less depressive symptoms. This may be due to a flaw in the 
measurement of negative interaction in relation to depressive symptoms. This study used 
perceived availability of negative interactions while research suggest that the best measure 
of negative interaction in relation to mental health outcomes is the frequency with which 
such interactions are directed towards the target person (Finch et al., 1999). 
  
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2.3.3 Demographic Variables  
Several demographic variables or factors have been studied in the mental health literature. 
In some studies, age, employment status, education, gender, marital status among others 
have been found to be significant predictors of mental and physical health (Brereton, 
Clinch & Ferreira, 2008; de Menil et al., 2012; Fisher & Baum, 2010; Shields & Price, 
2005) 
There is evidence that employment status is linked with both physical and mental health 
with most researchers finding unemployment to be positively related with psychological 
distress and negatively correlated with psychological well-being (Chandola, Clarke, 
Morris & Blane, 2006; Winefield, 2002). It is however not clear whether it is the 
employment that results in better psychological well-being or it is rather people who have 
better psychological well-being that are more likely to be employed (Winefield, 2002). 
Some researchers also indicate that it is not the employment that contributes to 
psychological well-being or distress but the quality of the work experience especially 
among women (Noor, 2008), thus employment can be a source of distress for some 
women depending on the work experience. Religiosity and social support have however 
been found to reduce the risk posed by stressful or negative work experience (Noor, 2008). 
It is therefore very useful for any research in the area of religiosity, social relationships 
and mental health to consider employment status as one of the control variables.  
Income has also been suggested to have effects on various mental health outcomes. For 
instance exploring household income as a predictor of psychological well-being among 
long-term colorectal cancer survivors, Lundy, Coons, Wendel, Hornbrook, Herrinton et al. 
(2009) found out that income predicted psychological well-being significantly. There was 
about 0.82 difference between those with the highest income level (>$ 100,000) and those 
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with the lowest income level (<$15,000) with those with high income level reporting 
better psychological well-being than those with low income.   
Gardner and Oswald (2006) in their longitudinal study of a random sample of British who 
received lottery wins of between £1000 and £ 120,000 compared this group to a control 
group who had no win or small win. Results show that those with medium win had better 
psychological health compared to the control group. 2 years after winning the lottery, their 
mental health was found to improve to about 1.4 on the General Health Questionnaire.  
The above evidences demonstrate the importance of income to an individual‟s mental 
health? This area should hence be a point of interest for mental health researchers. 
Marriage is one of the core values of the African culture (Gyekye, 1996) and many people 
in Ghana these days are eager to go into marriage due to the importance society places on 
marriage. Many researchers suggest that being married cushions some individuals from 
certain psychological distresses (Donald & Montgomery, 2009; Kim & McKenry, 2002; 
Uecker, 2012). That notwithstanding, the findings in this area has not been consistent. 
Some researchers suggest that the benefits of marriage in married individuals may not be 
different from that of other romantic relationships (Uecker, 2012) while others suggest that 
the benefits of marriage in predicting better psychological well-being after controlling for 
the quality of the relationship outweighs that of even cohabitation; which is the closest 
romantic relationship to marriage (Kim & McKenry, 2002). Continuous research is 
therefore needed to further investigate and explain the relationship between marital status 
and mental health. 
Apart from the above demographic variables, age, education and number of children are 
also indicated as predictors of mental health. Higher levels of education has been found to 
be associated with better mental health outcomes than lower levels of education, while 
higher number of children have been found to contribute to psychological distress 
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especially in women (de Menil et al., 2012; Ross, Mirowsky & Goldsteen, 1990;WHO, 
ICPE, 2000). Variables such as employment and  income may influence the relationship 
between education, number of children and mental health such that the educated are more 
likely to gain employment and earn higher income, while higher number of children 
results in more expenditure and thus putting more demand on the individual‟s income 
(Kim & Mckenry, 2002). The finding on age and mental health has not been conclusive. 
While some researchers believe age has a linear negative relationship with mental health, 
others think age is only significant in some individuals such as young adults and the 
elderly (de Menil et al., 2012; Noor, 2008; WHO, ICPE, 2000).  
The present research will therefore investigate the influence of age, education, 
employment, income, marital status and number of children on mental health among 
women in Accra in order to compare findings to what the literature asserts. 
 
2.4Summary 
Though no single theory may be self-sufficient in explaining the relationship between 
religiosity, social relationships and mental health, the most suitable theories for the 
purposes of the present study are the religious coping theory, the social exchange theory 
and the expectancy theory. It can be concluded from the theories and related studies 
reviewed that religiosity and social support have both direct and stress-buffering effects 
while social negativity has a direct and stress-exacerbating effects on mental health. The 
importance of considering both sides of social relationships in studying their effects on 
mental health has been emphasized, as well as studying both positive and negative mental 
health outcomes concurrently. It has also been made obvious that certain measures of 
religiosity especially organizational religiosity alone may not be reliable or strong enough 
in establishing any effect on mental health outcome. In using organizational religiosity, 
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positive social ties or religious social support will have to be controlled. The importance of 
considering demographic variables such as age, education, income, employment, marital 
status and number of children has also been enumerated. 
 
2.5 Rationale of the Study 
Despite the fact that Mental health forms a continuum between psychological well-being 
and psychological distress (Keyes, 2002; WHO, 2003), it is not a very common practice 
for studies to combine both positive and negative dimensions of mental health. This does 
not allow for a holistic picture of the relationship between mental health and other 
variables, consequently rendering the literature incomplete in this regard. Studies often 
look at one or more dimensions of either positive or negative side of mental health. These 
include depression, anxiety, subjective well-being, psychological well-being, life 
satisfaction, coping and other forms of psychopathology. In this “age of positive 
psychology” in which researchers are becoming more interested in positive mental health 
and not just psychopathology (Abdel-Khalek, 2011), it is important for studies to measure 
both positive and negative sides of mental health holistically. The present study therefore 
measures both psychological distress and psychological well-being in one measure of 
mental health. 
Another important issue to consider is that, even though organizational religion has been 
the most used measure of religiosity in the literature, its reliability has been criticized 
(Flannelly, Ellison, & Strock, 2004; Hall, Meador & Koenig, 2008). For instance, 
according to Flannelly, et al. (2004), „„although knowing that a person belongs to a 
specific religious denomination implies something about the nature of one‟s beliefs, it 
does not provide information about the strength of those beliefs or one‟s adherence to the 
practices of that faith‟‟ (p. 1234).  Moreover, as Africans are said to be inherently 
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religious, it may not take affiliation to a religious group or organization to make a person 
religious (Gyekye, 1996) hence the use of organizational religion in measuring religiosity 
would not be appropriate in this culture. Perhaps dimensions of religiosity such as strength 
of religious faith, which measures the centrality of religion in one‟s life, regardless of 
religious affiliation or attendance (Plante & Boccaccini, 1997a) would probably be a better 
option. It is also clear that religiosity is a multidimensional construct (Green &Elliot, 
2010) and while some dimensions have been found to have associations with mental 
health outcomes, others have been found to have no significant associations with mental 
health. The present study therefore employs strength of religious faith in measuring 
religiosity among women in Accra. 
The impact of social relationships or interactions on mental health may be best illustrated 
by comparative studies of negative social interactions and the availability of social support 
(Flett et al., 1997). Studies however focus mostly on social support and often neglect 
social negativity even though the few studies done in this area seem to indicate that social 
negativity had significant negative impact on mental health outcomes and some have even 
suggested that social negativity had more potent influence on mental health than social 
support (Bertera, 2005; Finch et al., 1999; Rook, 1997). Moreover the appropriate measure 
of both social support and social negativity has been an issue of controversy in the 
literature. Researchers are still at a loss as to which aspect of social support and social 
negativity is important to mental health outcomes. It has however been demonstrated that 
the aspect of social support with the highest effect size is perceived availability of support 
while the aspect of social negativity with the highest effect size is the frequency of 
negative social interactions directed at the target person (Finch et al., 1999). The present 
study investigates both sides of social relationship (social support and social negativity) to 
ascertain their influence on mental health of women. The measures used for social support 
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and social negativity are; perceived availability of support and frequency of negative 
socio-emotional interactions respectively.  
Furthermore, while there is a suggestion that religiosity and social relationship may have 
direct effects on mental health, many of the theories explaining the influence of both 
religiosity and social relationship on mental health have suggested that stress plays an 
important role in the relationship (Ingersoll-Dayton, et al., 1997; Lowe, et al., 2010; 
Smith, et al., 2003). Yet not all studies in these areas consider the role of stress in the 
relationship.  The direct effects of religiosity and social relationship on mental health as 
well as the moderating effects of stress are investigated in the present study. 
Finally, the present study uses both clinical and non-clinical sample, which allows for 
comparisons to be made between the groups, and the focus on the mental health of women 
is another feature that differentiates this study from the others. 
 
2.6 Statement of Hypotheses 
From the theories and related studies reviewed, the following hypotheses were proposed: 
1. Religiosity will have a significant positive relationship with psychological well-
being, overall mental health index and a significant negative relationship with 
psychological distress among women. 
2. Social support will have a significant positive influence on mental health among 
women. 
3. Women who report high social negativity will report lower psychological well-
being, higher psychological distress and lower overall mental health index than 
those who report low social negativity. 
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4. History of mental illness will moderate the relationship between religiosity, social 
support, social negativity and mental health. 
5. Stress will moderate the relationship between religiosity and mental health 
6. Stress will moderate the relationship between social support, social negativity and 
mental health. 
7. Age, education, marital status, employment, income and number of children will 
significantly predict mental health. 
Research Variables: 
Independent variables: religiosity, social support and social negativity 
Dependent variable: Mental health (psychological distress, psychological well-being and 
mental health index) 
Demographic variables: age, income, employment status, marital status, education and 
number of children 
Moderating variables: stress and history of mental illness 
 
  
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2.7 Hypothesized Conceptual Model 
 
 
 
 
  
 
 
 
 
 
  
 
 
Figure 1Hypothesized relationships among research variables 
 
The conceptual model in figure 1 shows that, religiosity, social support and social 
negativity will influence mental health, stress and history of mental illness will moderate 
the relationship between religiosity, social support, social negativity, and mental health, 
demographic variables will also influence mental health. 
 
 
 
 
 
 
MENTAL HEALTH 
 
 
RELIGIOSITY 
SOCIAL SUPPORT 
SOCIAL NEGATIVITY 
DEMOGRAPHIC  
VARIABLES 
History of mental illness 
Stress 
 
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2.8Operational Definition of Terms 
Religiosity: Strength of religious faith as measured by the Santa Clara Strength of 
religious faith Scale. 
Mental health: this includes scores on: 
1. Psychological well-being global subscale on the Mental Health Inventory  
2. Psychological distress global subscale on the Mental Health Inventory 
3. Mental health index on the Mental Health Inventory  
Social support: perceived care, assistance and empathy from family, friends and 
significant others as measured by the Multidimensional Scale of Perceived Social 
Support  
Social negativity: perceived negative social interactions such as criticism, 
arguments, disappointment etc. from family, friends and significant others; as 
measured by the Social negativity questionnaire. 
Stress: scores on the Perceived Stress Scale 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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CHAPTER THREE 
METHODOLOGY 
3.1 Introduction 
This chapter provides detailed information on the research design employed in achieving 
the research objectives in addition to methods used in the collection of empirical data 
(instruments), characteristics of study population, research design, sample, sampling 
technique, and procedure for data collection. 
 
3.2 Population 
Women living in Accra during the period of the study were the target population for the 
study. This included women with mental illness attending Accra Psychiatric hospital and 
Pantang Hospital for review on outpatient basis as well as women without any history of 
mental illness living or working in Adenta, Madina and Legon. Accra is highly populated 
and made up of diverse ethnic groups (AMA, 2011); hence it is more representative of the 
Ghanaian society than other cities and towns of Ghana. It also has two of the three major 
public psychiatric hospitals in Ghana as well as other private psychiatric facilities that 
provide treatment for various kinds of mental disorders.  
Accra Psychiatric hospital is the oldest public psychiatric hospital in Ghana, located in the 
heart of Accra (Adabraka) and renders all kinds of psychiatric and psychological services 
on inpatient and outpatient basis. Pantang Hospital serves as both a general and psychiatric 
hospital, hence provides general medical services (on outpatient basis) and psychiatric 
services (on both outpatient and inpatient basis). The most common psychiatric disorders 
diagnosed and treated on outpatient basis in these two hospitals include; Schizophrenia, 
Seizure disorder, mood disorders, anxiety disorders, substance abuse disorders, acute 
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psychotic disorder, dementia, and mental retardation (Records department, Accra 
Psychiatric Hospital & Pantang Hospital, March 2013).  
Adenta, Madina and Legon belong to the Adentan Municipal Assembly, La-Nkwantanang 
municipal assembly and Ayawaso-west sub-metro (of the Accra Metropolitan Assembly) 
respectively. These areas were selected because of the diverse nature of their inhabitants 
as well as its convenience to the researcher. Since the research is interested in participants 
from diverse socio-economic backgrounds, it was prudent to collect data from a sample 
that is made up of diverse characteristics in order to allow for maximum variation. Due to 
the diversity of the population in these communities, there is a high probability of the 
population being normally distributed. 
 
3.3 Sampling Technique 
The Purposive and convenient sampling techniques were used in selecting the target 
sample for the present study. The purposive sampling technique was employed because 
the sample was selected first of all from the population of women. The researcher was 
interested in certain subgroups within the population; women with mental illness and those 
who have no history of mental illness; hence these subgroups were selected purposively 
based on their history of mental illness. Also participants were selected based on their 
availability and willingness to take part in the study. 
 
3.4 Sample 
In all two hundred (200) participants were selected for the study. Ninety-two (92) out of 
the total sample; representing forty-six percent (46%) had a history of various mental 
illnesses ranging from Schizophrenia, mood disorders, anxiety disorders, acute psychotic 
disorders among others, who were in remission state and attending psychiatric hospital for 
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review of earlier treatment (on outpatient basis). These participants were purposively and 
conveniently selected at 2 different points- Accra Psychiatric Hospital and Pantang 
Hospital.  
One hundred and eight (108) out of the total sample size; representing fifty-four percent 
(54%) had no history of mental illness. They were randomly selected from Adenta, 
Madina, and Legon. In addition, some of the women who are caregivers of people living 
with mental illness (who accompanied them to the hospital or came to take their drugs for 
them) were also selected as part of the group with no history of mental illness. Women 
selected from the various communities who have a history of mental illness were excluded 
from the comparison group (no history of mental illness group).  
The sample size selected was deemed appropriate because according to Field (2009), in 
order to analyze data using multiple regression and obtain a medium effect size (.8), a 
sample size of 200 is enough for up to 20 predictors and with 6 or less predictors, a sample 
size of 100 is adequate. The maximum number of predictors used in the present study was 
6. 
The demographic characteristics of participants are summarized in Table 1. 
 
 
 
 
 
 
 
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Table 1  
Demographic Characteristics of Participants 
 
Demographic variable 
 
Frequency  
 
Percentage  
Age 
 18-29 
30-49 
50-64 
65 and above 
Missing 
Total  
 
92 
73 
28 
6 
1 
200 
 
46 
36.5 
14 
3 
0.5 
100 
Level of education 
Primary/below 
JHS 
Secondary/technical/vocational 
Tertiary  
Postgraduate  
Total  
 
33 
35 
39 
58 
35 
200 
 
16.5 
17.5 
19.5 
29.5 
17.5 
100 
Monthly income in Gh cedis 
Below 500 
500-2000 
2000-3000 
Above 3000 
Missing 
Total  
 
130 
55 
11 
3 
1 
200 
 
65.3 
27.6 
5.5 
1.5 
0.5 
100 
Employment  
Formal 
Informal  
Unemployed 
Retired  
Missing  
Total  
 
64 
52 
78 
5 
1 
200 
 
32 
26 
39 
2.5 
0.5 
100 
Marital status 
Single/never married 
Married 
Separated 
Divorced 
Widowed  
Total  
 
99 
64 
10 
17 
10 
200 
 
49.5 
32 
5 
8.5 
5 
100 
Number of children 
None  
1 
2 
3 
4 or more 
Total  
 
86 
29 
29 
31 
25 
200 
 
43 
14.5 
14.5 
15.5 
12.5 
100 
Religion  
None/traditional 
Muslim  
Christian  
 
2 
25 
17 
 
  1 
12.5 
86.5 
 
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3.5 Inclusion and Exclusion Criteria 
The inclusion and exclusion criteria include the following: 
 Participants must be women, 18 years and above and residing in Accra at the time 
of data collection.  
 Women in the mental illness group must have a history of mental illness, and must 
have had prior treatment and reporting for review at either Accra psychiatric 
hospital or Pantang Hospital.  
 Participants must be capable of responding to the questions on the questionnaires.  
 Women in the comparison group must have no history of mental illness (either past 
or present).  
 Individuals who answered “yes” on the history of mental illness question on the 
demographic questionnaire and/or at least one “yes” on items 3, 4, 5, and 9 on the 
Mental Health Screening Form III were those included in the mentally ill group.  
 
3.6 Measures 
Data was collected on the research variables using the following measures/instruments: 
Demographic Variables 
Demographic questionnaire was used to collect data on demographic characteristics of 
participants such as age, education, income, marital status, number of children and history 
of mental illness 
Religiosity 
The Santa Clara Strength of Religious Faith Questionnaire [SCSRFQ] (Plante & 
Boccaccini, 1997) was used to assess religiosity. This is a 10-item scale which is used to 
measure the strength of a person‟s religious faith regardless of one‟s religious affiliation. 
Scores on the scale range from 10 to 40 on a 4-point Likert scale (1= strongly disagree, 2= 
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disagree, 3= agree and 4= strongly agree) with higher scores indicating stronger religious 
faith. Plante & Boccaccini, (1997b) report an internal consistency (cronbach alpha) of .95 
and a split half reliability of .92. Several studies have also reported cronbach alpha ranging 
from .94 to .97 (Plante, 2010). The scale is also reported to have been used among 
different populations including students, psychiatric, medical and substance abuse samples 
as well as in diverse cultures and languages (Plante, 2010). Even though there are several 
scales available for assessing religiosity, the SCSRFQ was used in the present study 
because of its suitability for use with multiple religious affiliations as well as for people 
without any interest in or affiliation with religious organizations and the availability of 
empirical studies among several populations (Plante, 2010; Plante & Boccaccini, 1997b). 
In the present study, the internal consistency of the SCSRFQ was .95.Sample items 
include: “my religious faith is extremely important to me” and “I look to my faith as a 
source of inspiration”. 
Social support 
Social support was assessed using the Multidimensional Scale of Perceived Social 
Support [MSPSS] (Zimet, Dahlem, Zimet & Farley, 1988). It is a 12-item scale that 
measures an individual‟s perception of how much he or she receives outside social support 
from three sources; family, friends and significant others on a 7-point Likert scale from 
very strongly disagree to very strongly agree. Scores range from 7 to 84 and higher scores 
reflect higher levels of perceived social support. It has been widely used in both clinical 
and non-clinical samples of different ages and cultural background and has been reported 
to be valid and reliable. Good cronbach alpha has also been reported; ranging from .81 to 
.98 for non-clinical samples and .92-.94 for clinical samples (Clara, Cox, Enns, Murray & 
Torgrude, 2003; Zimet et al. 1988; Zimet, Powell, Farley, Werkman & Berkoff, 1990). 
One peculiar feature of this scale is the fact that it does not only measure perceived social 
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support but also the source of the support (Zimet et al., 1988). The present study also 
recorded good internal consistency on the MSPSS; r = .92. Sample items are: "There is a 
special person who is around when I need help”, “my family really tries to help me” and “I 
can count on my friends when things go wrong”. 
Social negativity  
According to Finch et al. (1999), the most potent measure of negative social interactions 
for mental health is the frequency of negative socio-emotional exchanges. Based on this 
assertion, the following six (6) questions about the frequency of perceived negative socio-
emotional interactions were used to assess social negativity; “how frequently do you argue 
with your relatives or friends or significant others”, “how often do your relatives or 
friends or significant others criticize you”, “how often do your relatives or friends or 
significant others let you down”, “how often do you experience excessive demands put on 
you by your family or friends or significant others”, “how often does your family or 
friends or significant others  get on your nerves”, “how often does your family or friends 
or significant others make you feel tense”.  These questions were repeated three times to 
assess social negativity from three sources; family, friends and significant others so that 
the sources of social negativity corresponds with that of social support. The items were 
scored on a 4-point Likert scale (1= never 2= rarely 3= sometimes 4= often). Higher 
scores on the questionnaire indicate higher levels of social negativity and scores range 
from 18 to 72. Factor analysis confirmed three factors in the present sample; social 
negativity from friends, significant others and family or relatives. Similar items were used 
by Bertera (2005) but the sources of social negativity differ slightly. In Bertera‟s (2005) 
study, the sources of social negativity assessed were; spouse, relatives and friends. 
Reliability coefficient reported ranged from .81 to .89. Walen and Lachman (2000) also 
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used similar items in their study and reported cronbach alpha ranging from .79 to .86.In 
the present study, the internal consistency for the entire questionnaire was .87. 
Stress 
The Perceived Stress Scale-10 (PSS-10) developed by Cohen and Williamson (1988) was 
used to assess participants‟ level of stress. It measures the degree to which situations in a 
person‟s life are interpreted as stressful. Items were designed to ascertain how 
unpredictable, uncontrollable, and overloaded respondents find their lives. The questions 
in the PSS-10 ask about feelings and thoughts during the last month. In each case, 
respondents are asked how often they felt a certain way. The questions are general in 
nature and thus are relatively devoid of content that is specific to any subpopulation. 
Cohen and Williamson (1988) reported a cronbach alpha of .78. Even though there are 
three versions of the scale (PSS-14, PSS-10; PSS-4), the 10-item version is reported to 
have superior psychometric properties compared to the other versions (Lee, 2012). In the 
present study, the internal consistency of the scale was r = .78. Each item on the PSS is 
scored on a 5-point Likert scale; 0= never, 1= almost never, 2= sometimes, 3= fairly often, 
4= very often. Scores are obtained by reversing responses (e.g., 0 = 4, 1 = 3, 2 = 2, 3 = 1 & 
4 = 0) on the four positively stated items (items 4, 5, 7, & 8) and then summing across all 
scale items. Higher scores on the scale indicate more perceived stress. Sample items 
include: “In the last month, how often have you felt that you were unable to control the 
important things in your life” and “In the last month, how often have you felt nervous and 
stressed”. 
Mental Health  
The Mental Health Inventory (MHI-38) which was developed by Veit and Ware (1983) 
was used to measure mental health. It is a 38-item scale which asks about respondent‟s 
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feelings during the past month (Vilchinsky & Kravetz, 2005). It contains six subscales 
which measure Anxiety, Depression, Loss of Behavioural/Emotional control, General 
Positive Affect, Emotional Ties and Life Satisfaction, these subscales can be grouped into 
two global subscales namely; psychological well-being and psychological distress 
(psychological well-being- General Positive Affect, Emotional Ties and Life Satisfaction; 
psychological distress- Anxiety, Depression and Loss of Behavioural/Emotional control ). 
Items on the scale can also be scored into one mental health index. Each item is scored on 
a 6-point likert scale in exception of two items; 9 and 28 which are scored on a 5-point 
likert scale. High scores on each of the subscales indicate high levels of the construct 
being measured. Due to this, items are sometimes reverse-scored in order to reflect high 
levels of the construct being measured (Davies, Sherbourne, Peterson & Ware, 1998). 
Scores on the psychological well-being, psychological distress and mental health index 
global subscales range from 14-84, 24-142 and 38-226 respectively. The scale is reported 
to be highly reliable and valid (Veit & Ware, 1983). The MHI-38 subscales are found to 
correlate significantly with other scales measuring the same constructs (Vilchinsky & 
Kravetz, 2005). For the psychological well-being, psychological distress and mental health 
index subscales, Vilchinsky & Kravetz (2005) in their study found the internal consistency 
to be r =.92, r = .95 and r = .96 respectively, which is similar to Florian & Drory‟s (1990) 
findings (r = .91, r = .95and r = .96) respectively. The present study recorded .86, .89 and 
.88 for psychological well-being, psychological distress and mental health index subscales 
respectively. Examples of items on the scale include: “During the past month, how much 
of the time have you generally enjoyed the things you do”, “Did you feel depressed during 
the past month” and “How much of the time, during the past month, have you been a very 
nervous person”.  
 
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3.7 Research Design 
The cross-sectional survey design was used to collect data. This design enabled the 
researcher to collect information from women with diverse socio-economic backgrounds 
on certain characteristics, perceptions and attitudes (religiosity, social support, social 
negativity, mental health, perceived stress and some demographic variables) through the 
use of questionnaires and self-report measures and data was collected from the 
respondents only once.  
 
 
 
3.8 Procedure 
The research began with the researcher obtaining ethical approval from the Internal 
Review Board of the Noguchi Memorial Institute for Medical Research (NMIMR). Once 
the approval was granted, introductory letters from the department of Psychology were 
taken to the Greater Accra Directorate of the Ghana Health Service, Accra Psychiatric 
Hospital and Pantang Hospital informing them about the research.  After access to these 
institutions was granted, a pilot study was carried out at the Accra Psychiatric Hospital and 
Adenta Community in which twenty participants were used. This was to test the 
questionnaires on the sample to ascertain whether they are reliable among the sample and 
whether the items on the questionnaires are well understood by the participants. 
Data collection commenced after the pilot study by the principal investigator and two 
research assistants. Participants were screened for history of mental illness using the 
Mental Health Screening Form III (Carroll & McGinley, 2000; 2001). This is a 
screening test designed to detect whether an individual has a past or present history of 
mental illness. It has items numbered from 1 to 17 and each item is answered “yes” or 
“no”. Item 6 is however in two parts, making the total items on the test, 18. The MHSF III 
reflects history of symptoms of Schizophrenia, depressive disorders, post-traumatic stress 
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disorder (PTSD), phobias, delusional disorder, manic episode, eating disorders, 
intermittent explosive disorder, pathological gambling, learning disorder and mental 
retardation. Each question refers to a person‟s entire life and not just current 
circumstances, so each question begins; “have you ever…”  According to Sacks, Melnick, 
Coen, Banks, Friedman, et al. (2007), a total score of 3 or above had an overall accuracy 
of about 73% of identifying mental disorder.  
Only four items (3, 4, 5, and 9) on the scale were used in the present study. These items 
reflect a history of psychiatric treatment (3, 4), symptom of Schizophrenia (5), and 
intermittent explosive disorder (9). Factor analysis revealed that these items loaded on a 
single factor with factor coefficients ranging from .7 to .8. From pilot study, it was 
observed that some of the items were not discriminatory enough to establish whether a 
person has a history of mental illness or not; they were therefore not used in the grouping 
of participants. The four items used are: “have you ever been advised to take medication 
for anxiety, depression, hearing voices, or for any other emotional problem?”;  “have you 
ever been seen in a psychiatric emergency room or been hospitalized for psychiatric 
reasons?”; “have you ever heard voices no one else could hear or seen objects or things 
which others could not see?”; and  “have you ever given in to aggressive urge or impulse, 
on more than one occasion that resulted in serious harm to others or led to the destruction 
of property?”. The internal consistency of the scale in the present study was .79.  
Participants were required to complete an informed consent form, indicating their 
willingness to participate in the study before proceeding to fill the questionnaires. These 
forms described the topic and methods of the study and the voluntary and confidential 
nature of participation. Once the forms were signed, each of the participants went on to fill 
the questionnaires. Data collection in the two hospitals was done while patients who report 
at the outpatient department for review were waiting in queues for their turn to be attended 
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to. Data collection was however done as privately as possible; as participants who were 
willing to take part in the study were isolated from the queue and made to join the queue 
after completing the questionnaires. Items on the questionnaires were read out to 
respondents who were unable to read. Throughout the administration of these procedures, 
the researcher and research assistants were available to answer questions from 
respondents. Data collection among participants in the comparison group was carried out 
at their residence and offices. 
 
  
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CHAPTER FOUR 
RESULTS 
This chapter presents results of the analyses done with the data collected. To test the 
hypotheses stated, the SPSS version 16.0 was used to analyze the data using Pearson 
product moment correlation, Multiple Regression, and Multivariate Analysis of Variance 
(MANOVA).  
 
4.1 Descriptive Statistics 
The summary of the means and standard deviations of scores on religiosity, social support, 
social negativity, perceived stress, and the mental health outcomes (psychological well-
being, psychological distress and mental health index) as well as internal consistency of 
scales are presented in Table 2. 
Table 2 
Means, Standard Deviation and Cronbach Alpha of Variables 
Variables Mean Standard Deviation                Cronbach alpha (α) 
Religiosity                                        34.41                       6.95                             .95 
Social support                                  57.26                      16.89                            .92 
Social negativity                              39.32                       9.22                             .87 
Perceived Stress                               15.12                      6.63                             .78 
Psychological well-being                 58.88                       11.30                            .86   
Psychological distress                      61.18                       18.99                            .89 
Mental health index                        157.37                        21.30                           .88 
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Table 3 
Correlation Matrix representing the Relationship among Variables 
VA 1 2 3 4 5 6 7 8 9 10 11 12 13 14 
RA               
REL .12*              
SS .01 .16*             
SN -.10 -.13* -.06            
MI -.05 -.10 -.07 .01           
Str -.08 -.12* -.03 .11 .21**          
PW .08 .26** .07 -.21** -19** -.66**         
PD -.06 -.24** -.07 .23** .41** .76** -.71**        
MH .06 .22** .07 -.22** -.32** -.74** .88** -.92**       
Age  -.06 .06 .06 -.11 .40** .08 -.01 .09 -.07      
Edu .04 .20 .12* .08 -.47** -.20** .03 -.25* .18** -.40**     
Inc .02 .06 .10 -.05 -.08 -.01 .07 -.14* .10 .16* .31**    
Chil .00 .04 .09 -.15* .30** .09 .10 .02 .01 .68** -.41** .05   
MS -.04 .03 -.024 -.17** .26** .08 -.04 .11 -.11 .69** -.40** .02 .60**  
Emp -.06 .25** -.15* .00 .17** .08 .09 .11 -.06 .20** -.50** -.25** .31** .25** 
*Significant at the .05 level of significance (1-tail) **significant at the .01 level of significance (1-tail) 
Variables (VA) : religious attendance (RA), Religiosity (REL), social support (SS), social negativity (SN), history of mental illness (MI), stress (Str), 
psychological well-being (PW), psychological distress (PD), mental health index (MH), age, education (Edu), income (Inc), number of children 
(chil), marital status (MS), employment status (Emp).
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4.2 Hypotheses Testing 
Hypothesis 1: Religiosity will have a significant positive relationship with psychological 
well-being and overall mental health index and a significant negative relationship with 
psychological distress among women. 
To analyze this hypothesis, Pearson product moment correlation analysis was performed 
to find out the relationship among the various variables. From results as presented in Table 
3, religiosity had a significant positive relationship with psychological well-being (r(198) 
= .26, ρ<.01), a significant negative relationship with psychological distress (r(198) = -.24, 
ρ<.01) and a significant positive relationship with overall mental health index (r(198) = 
.22, ρ<.01). The stated hypothesis was therefore supported.  
 
Hypothesis 2: Social support will have a significant positive influence on mental health 
outcomes among women 
Table 3 shows that social support did not have significant relationship with any of the 
mental health outcomes even though there was a trend of positive relationship with 
psychological well-being and overall mental health index and a negative relationship with 
psychological distress (r(198) = .07, ρ>.05; r(198) = -.07, ρ>.05; r(198) =.07, ρ>.05). 
There was therefore no need for further analysis, which means that the stated hypothesis 
that “social support will have a significant positive influence on mental health” was not 
supported.  
 
 
 
 
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Hypothesis 3: Women who report high social negativity will report lower psychological 
well-being, higher psychological distress and lower overall mental health index than those 
who report low social negativity. 
This hypothesis was analyzed using MANOVA after the participants were grouped into 
two groups based on the overall mean score of the sample (~39) in order to ascertain the 
difference between the mean scores of women who reported high level of social negativity 
and those who reported low level of social negativity on the three mental health outcomes. 
The multivariate test shows that a significant difference exists between the groups [F(3, 
196)= 6.38, ρ< .05; 2 = .089; Wilk‟s Lambda = .91]. The summary of the results from the 
means of the groups on the various mental health outcomes and MANOVA are presented 
in Table 4:  
 
Table 4 
Summary of Means and MANOVA Results of the Influence of Social Negativity on the 
Various Mental health Outcomes. 
Dependent variable Low SN High SN df F ρ 2 
Psychological well-
being 
61.20 56.27 1, 198 9.91 .002 .048 
Psychological distress 56.18 66.83  16.89 .000 .079 
Mental health index 162.29 151.82  12.76 .000 .061 
 
The MANOVA results in Table 4clearly shows that a significant difference exists between 
the two groups being compared on all the mental health outcomes at the .05 level of 
significance [F (1,198) = 9.909, ρ< .05; 2 = .048]; [F (1,198) = 16.888, ρ< .05; 2 = .079]; 
[F (1,198) = 12.760, ρ< .05; 2 = .061] for psychological well-being, psychological 
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distress and mental health index respectively. The means of the groups show that, those 
who reported low social negativity had higher psychological well-being, lower 
psychological distress and higher overall mental health compared to those who reported 
high social negativity (61.20> 56.27; 56.18< 66.82; 162.29> 151.82). The findings 
therefore supported the stated hypothesis that “women who report high social negativity 
will report lower psychological well-being, higher psychological distress and lower overall 
mental health index than those who report low social negativity”. 
 
Hypothesis 4: History of mental illness will moderate the relationship between religiosity, 
social support, social negativity, and mental health. 
To find out whether history of mental illness moderated the relationship between 
religiosity, social support, social negativity and mental health, the hierarchical multiple 
regression analysis was used, but social support was not included in the analysis since it 
had no relationship with mental health. Results from the analyses are summarized in Table 
5. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Table 5 
Hierarchical multiple regression analysis results of the moderation effects of history of 
mental illness on the relationship between religiosity, social negativity and mental 
health 
Predictors B SEB  t ρ 
1 Constant 133.75 7.48  17.88 .000 
Religiosity .69 .21 .22 3.23 .001 
Social negativity -.52 .16 -.22 -3.19 .002 
2 constant 142.80 7.42  19.24 .000 
Religiosity .59 .21  .19 2.91 .004 
Social negativity -.51 .15 -.22 -3.33 .001 
HMI -12.76 2.85 -.30 -4.48 .000 
3 constant 143.25 7.45  19.22 .000 
Religiosity .59 .21  .19 2.85 .005 
Social negativity -.63 .16 -.27 -3.82 .000 
HMI -12.74 2.85 -.30 -4.47 .000 
Rel*HMI 1.07 1.42  .05 .75 .454 
SN*HMI 2.82 1.47 .14 1 .91 .057 
 
Results from table 5 demonstrate that the interaction between religiosity and history of 
mental illness was not significant ( = .05; t = .750, ρ > .05) which means that history of 
mental illness did not moderate the relationship between religiosity and mental health.It 
also did not moderate the relationship between social negativity and mental health since 
the interaction between social negativity and history of mental illness was not significant 
( = .14; t = 1.912, ρ > .05). Also, table 3 reveals that history of mental illness was not 
significantly related to religiosity, social support and social negativity(r(198) = -.10, ρ > 
.05; r(198) = -.07, ρ > .05; r(198) = .01, ρ > .05). It can be inferred from these findings 
that the effects of religiosity, social support and social negativity is similar in both groups. 
The hypothesis which stated that “history of mental illness will moderate the relationship 
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between religiosity, social support and social negativity and mental health” was therefore 
not supported. 
Hypothesis 5: Stress will moderate the relationship between religiosity and mental health 
 
To test this hypothesis, the Hierarchical Multiple Regression analysis was used. Table 6 
represents the summary of findings. 
Table 6 
Hierarchical Multiple Regression Analysis of the Moderation Effect of Stress on the 
Relationship between Religiosity and Mental health. 
Predictors B SEB  t ρ 
1 constant 133.75 7.48  17.88 .000 
Religiosity .69 .21 .22 3.23 .001 
2 constant 177.80 5.84  30.44 .000 
Religiosity .43 .15 .14 2.94 .004 
Stress -2.33 .15 -.72 -15.23 .000 
3 constant 174.83 5.84  29.96 .000 
Religiosity .51 .15 .17 3.48 .001 
Stress -2.33 .15 -.72 -15.54 .000 
Rel*stress -2.804 .10 -.13 -2.81 .005 
1 R2= .050, ρ= .001 2 ΔR2= .515, ρ= .000 3 ΔR2= .017, ρ= .005 
 
From Table 6, religiosity and stress individually predicted mental health significantly at 
the 0.05 level of significance. Religiosity predicted about 17% variance in mental health 
( = .17, ρ < .05); stress predicted about 72% reduction in mental health ( = -.72, ρ< .05) 
and the interaction term between them was also significant ( = -.13, ρ< .05). The finding 
shows that stress moderates the relationship between religiosity and mental health. The 
interaction term being negative means that religiosity reduces the negative influence of 
stress on mental health or vice versa. The hypothesis which states that stress will moderate 
the relationship between religiosity and mental health was therefore supported. 
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Hypothesis 6: Stress will moderate the relationship between social support, social 
negativity and mental health 
This hypothesis was analyzed using the Hierarchical Multiple Regression analysis, but 
social support was not included in the analysis since it had no significant relationship with 
mental health; only social negativity was used in the analysis. The analysis for the 
moderation effect of stress on the relationship between social negativity and mental health 
is contained in Table 7. 
Table 7 
Hierarchical Multiple Regression Analysis of the Moderation Effect of Stress on the 
Relationship between Social negativity and Mental health. 
Predictors B SEB  t Ρ 
1 constant 177.67 6.52  27.23 .000 
Social negativity - .52 .16 -.22 -3.19 .002 
2 constant 205.58 4.76  43.17 .000 
Social negativity .428 .15 .14 -2.94 .004 
Stress -2.33 .15 -.73 -15.35 .000 
3 constant 174.83 5.84  42.99 .000 
Social negativity .51 .15 -.15 -3.02 .003 
Stress -2.33 .15 -.72 -14.97 .000 
SN*stress -2.80 .10 .04 .71 .478 
1 R2= .049, ρ= .002 2 ΔR2= .520, ρ= .000 3 ΔR2= .001, ρ= .478 
From Table 7, social negativity and stress individually predicted mental health 
significantly (= .15, ρ< .05; = -.72, ρ<.05). The interaction term between them was 
however not significant (= .04, ρ>.05). This means that stress did not moderate the 
relationship between social negativity and mental health. Hypothesis 6 which states that 
“stress will moderate the relationship between social support, social negativity and mental 
health” was not supported. 
 
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Hypothesis 7: Age, education, marital status, employment, income and number of 
children will predict mental health 
From the correlation matrix (Table 3), only income and education had significant 
relationships with mental health, so only income and education were used in the analysis. 
To test this hypothesis, the variables were re-coded into dummy variables and the multiple 
regression analysis was used to analyze the data. For income, those who earned below 500 
GH cedis were used as a reference group, and for education, primary level was used as the 
reference group. Only one significant model emerged; the model with education [R2= .07; 
F= 3.59, ρ<.05] and the model accounted for 7% variance in mental health index. The 
model for age did not significantly predict mental health [R2= .01; F= .83, ρ> .05]. 
Further analysis was done to ascertain the individual contributions of the various levels of 
education on mental health. The results of the individual contributions are presented in 
Table 8. 
 
Table 8 
Multiple Regression Analysis of the Contributions of Levels of Education to Mental 
health 
Predictors B SEB  t ρ 
Primary vs. JHS -2.57                5.038                    - .046            -.511               .610 
Primary vs. secondary -2.002             4 .911                    -.037          -.408            .684 
Primary vs. tertiary 1.12               4.527  .024             .248           .804 
Primary vs. postgrad 13.54           5.038                      .242             2.688         .008 
R2= .07, ρ= .008 
 
Table 8 shows that a difference between primary education and JHS did not predict a 
significant variance in mental health at the 0.05 level of significance [t= -.511, ρ> .05], 
likewise secondary and tertiary levels [t= -.408, ρ> .05]; [t= .248, ρ> .05] respectively. The 
difference between primary and postgraduate education however accounted for a 
significant variance in mental health; the difference accounted for 24% variance in mental 
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health [ = .24; t = 2.69, ρ< .05]. The hypothesis which states that “age, education, marital 
status, employment, income and number of children will predict mental health” was not 
supported. 
4.3 Additional Findings 
To find out which of the independent variables (religiosity, social support and social 
negativity) was the best predictor of psychological well-being among women, multiple 
regression analysis was done. Since social support did not have significant relationship 
with psychological well-being, it was not included in the multiple regression analysis, only 
religiosity and social negativity were used in the analysis. Results reveal that religiosity 
predicted 24% variance in psychological well-being which was statistically significant at 
the 0.05 level of significance ( = .24; t = 3.46, ρ < .05) while social negativity predicted 
18% reduction in psychological well-being  and this was also statistically significant at the 
0.05 level of significance ( = -.18; t = -2.63, ρ < .05)[see appendix k]. This finding 
indicates that religiosity accounted for more variance in psychological well-being than 
social negativity. It can therefore be concluded that religiosity is the best predictor of 
psychological well-being among women in Accra. 
4.4 Summary of Findings 
1. Religiosity had a significant positive relationship with psychological well-being and 
overall mental health index and a significant negative relationship with psychological 
distress. 
2. Social support did not have significant influence on mental health outcomes. 
3. Women who reported high social negativity reported lower psychological well-being, 
lower overall mental health index and higher psychological distress compared to those 
who reported low social negativity. 
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4. Stress predicted mental health significantly and also moderated the relationship 
between religiosity and mental health but did not moderate the relationship between 
social negativity and mental health. 
5. Among the demographic variables tested, only a difference between primary and 
postgraduate education significantly predicted mental health. 
6. Participants‟ history of mental illness did not significantly influence their level of 
religiosity, social support and social negativity. History of mental illness also did not 
moderate the relationship between religiosity and mental health as well as social 
negativity and mental health. 
7. Religiosity was found to be the best predictor of psychological well-being compared to 
social negativity and social support. 
  
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4.5 Observed Conceptual Model 
The findings of the study are summarized in figure 2 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 2 Observed relationships among research variables 
 
  
 
Religiosity  
 
 
Social negativity 
 
Education  
 
 
 
Mental Health 
Stress 
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CHAPTER FIVE 
DISCUSSION 
5.1 Introduction 
The main aim of the study was to find out how religiosity, social support, social negativity 
and selected demographic variables influence the mental health of women and to find out 
if any difference exists between women with mental illness and those with no history of 
mental illness. The specific objectives were: to find out whether religiosity had a 
significant influence on mental health among women in Accra and the nature and direction 
of the relationship, to find out whether social support and social negativity have significant 
influence on the mental health of women, and to ascertain the dynamics of the association, 
to find out whether religiosity, social support and social negativity have the same or 
similar effects on women with mental illness as those who do not have any history of 
mental illness, to find out whether the relationship between religiosity, social support, 
social negativity and mental health is influenced by perceived stress, and to find out how 
women‟s demographic characteristics influence their mental health. 
To achieve the above aims and objectives, several hypotheses were tested. This chapter 
presents discussion of findings, limitations, recommendations and conclusions. 
  
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5.2 Discussion of Findings 
Religiosity and Mental Health Outcomes 
One of the objectives of the study was to find out whether religiosity had a significant 
influence on mental health among women and the nature and direction of the relationship. 
Findings show that religiosity had a significant influence on mental health outcomes. 
Religiosity was found to have a significant positive relationship with psychological well-
being and overall mental health index while it had a significant negative relationship with 
psychological distress. According to Dein et al. (2012), in collectivist cultures, 
individuality and the spirit world are closely interconnected, and in such cultures, mental 
health and spiritual health strongly reflect each other. From this perspective, it could be 
said that since the Ghanaian culture emphasizes collectivism, being religious is part of an 
individual‟s self-identity, hence being religious would reflect better mental health. Several 
other studies also found positive associations between measures of religiosity and various 
mental health outcomes (Bonelli & Koenig, 2013; Ismail & Desmukh, 2012). 
The relationship between religiosity and mental health in the present sample can be 
explained from a cognitive-behavioral framework, based on the religious coping theory 
(Pargament, 1997). An individual‟s religiosity is likely to provide a framework for 
forming mental schemas or models which guides his/her appraisals of life events, 
especially in stressful events and enables the individual to make meaning of his/her life 
(James & Wells, 2003). This mechanism has the potential of influencing mental health 
positively or negatively, depending on the content of the schema. The finding from the 
present study implies that women in Accra are more likely to form positive religious 
mental schemas which have positive influence on mental health.  
It was however found that religious attendance did not have a significant relationship with 
the mental health outcomes even though it had a trend towards a positive association. One 
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can therefore conclude that religious attendance is not an appropriate measure of 
religiosity among the present sample. Consistent with the present finding, Ellison et al. 
(2009) also found out that religious attendance did not have a significant relationship with 
mental health (depressive symptoms) after controlling for supportive social ties, but 
religious salience (which is similar to strength of religious faith) was found to have 
significant relationship with depressive symptoms after controlling for all other variables. 
Similarly, Green and Elliot (2010) found that when strength of religious identity and 
engagement in religious activities were entered together in the regression model, only 
strength of religious identity was significantly related with health. Ellison, et al., (2001) 
however found out that religious service attendance had a significant relationship with 
both psychological well-being and distress.  
Social support, Social negativity and Mental health 
The second objective of the present study was to find out whether social support and social 
negativity have significant influence on mental health of women and to ascertain the 
dynamics of the relationship. It was found out that social support did not influence mental 
health significantly. Even though several studies report positive influence of social support 
on mental health outcomes (Lowe et al., 2010; Mikulincer & Shaver, 2008; Walen & 
Lachman, 2000; Zhang, 2012), it has been noted that the positive influence of social 
support may be influenced by the quality of the relationship, thus the positive influence of 
perceived availability of support may be reduced by conflict in the relationships that may 
provide the support (Miller & Ray, 1994; Pierce, Sarason & Sarason, 1992). Vangelisti 
(2009) also illustrated that even though individuals may perceive the consequences of 
receiving support as positive, the cost of receiving such supports may sometimes be seen 
to overshadow the benefits, or perhaps the processes involved in receiving the support 
may be considered as adverse. In other instances, the available sources of support may be 
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perceived as incapable of giving the help needed; consequently, the positive influence of 
perceived support might not be felt by the individual. As Ghana is a collectivist culture 
whereby communalism and brotherhood are emphasized (Gyekye, 1996, Zhang, 2012), 
individuals are more likely to perceive the availability of social support from at least one 
source (no matter how low) hence the influence of perceived social support would largely 
depend on whether the available support is helpful or not. From this tenet, it could be 
inferred that women in the present study may not consider the social support available to 
them as helpful; hence it did not have a significant impact on their mental health or 
perhaps they perceive or experience unpleasant interactions from the same sources of 
support which overshadow the benefits of the support. 
From the social-cognitive perspective, perceived social support is based on an interplay 
among mental schemas about self, others and expectancies of the nature of interpersonal 
interactions (Pierce, Baldwin & Lydon, 1997). Perception of the availability of social 
support is found to be associated with expectation of positive exchanges from others and a 
positive self view (Pierce et al., 1991). Perceived social support is therefore considered to 
be related to more positive thoughts and emotions and less negative thoughts and emotions 
(Lakey& Drew, 1997). This perspective seems to be suggesting therefore that perceived 
social support is likely to have a positive influence on mental health, nonetheless whether 
this positive influence is significant or not is another argument all together. If an 
individual has expectations of both positive and negative interactions from the available 
sources of social support, the positive influence of the perceived social support may be 
neutralized, hence the effects of the support becomes insignificant, which might be the 
case in the present study.  
Social negativity was however found to have significant effects on mental health among 
women. It was found out that, women who reported high social negativity reported lower 
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psychological well-being, lower overall mental health and higher psychological distress 
while those who experienced low social negativity reported the contrary. These findings 
reveal that the aspect of social relationship most pertinent to the mental health of women 
in Accra is social negativity rather than social support. In fact several studies in which 
both positive and negative interactions were investigated concurrently, found positive 
interactions (social support) to have less impact on mental health compared to negative 
interactions (Bertera, 2005; Zhang, 2012); the results of the present study therefore 
confirms these earlier findings.  
Due to the emphasis on harmonious living in the Ghanaian culture, individuals‟ 
expectation of social interactions is that of pleasantness, negative interactions therefore 
deviate from this expectation. Consequently, the effects of these negative interactions will 
be more deleterious compared to the positive effects of positive interactions (Zhang, 
2012). The results of the present study however contradict other studies done in 
individualistic cultures which found social support to have more potent influence on 
mental health than social negativity or equal effects as social negativity (Jasinkaja-Lahti, 
2006; Lincoln, 2000; Walen & Lachman, 2000). 
 
Moderating Effect of Stress on the Relationship between Religiosity and Mental 
Health among Women 
The study also sought to find out whether the relationship between religiosity, social 
support, social negativity and mental health is influenced by perceived stress. Results 
revealed that stress significantly predicted a reduction in mental health and moderated the 
relationship between religiosity and mental health but did not moderate the relationship 
between social negativity and mental health.  
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As postulated by theorists, religiosity influences mental health by either reducing exposure 
to stress or providing coping resources for coping with stress (Ellison, 1994; Grasmick, 
Bursik & Cochran, 1991; Pargament, 1997), the present study found out that strength of 
religious faith had a negative relationship with stress. This indicates that those who are 
more religious are more likely to perceive less stress, which translates into better mental 
health. The interaction between religiosity and stress was found to be negative, which 
means that religiosity might be buffering the negative influence of stress on mental health. 
The finding is consistent with studies which reported an interaction effect between 
religiosity and stress on mental health outcomes (Smith et al., 2003; Ward, 2010; Wei & 
Liu, 2013). Some studies however did not find any interaction between religiosity and 
stress on mental health outcomes (Tabak &Mikelson, 2009).  
The finding however contradicts studies which found interaction between stress and social 
relationships (positive and negative interactions) on mental health outcomes (Ingersoll-
Dayton et al., 1997; Lincoln et al., 2005; Lowe et al., 2010). Unlike individualistic 
cultures where studies found an interaction effect between stress  and social relationships, 
Ghana has a collectivist culture hence social relationships are an integral part of the 
society, hence social relationships are very important to the individual whether the 
individual is going through stress or not. The perception of stress therefore does not make 
any difference in the relationship between social relationships and mental health.   
Demographic variables and Mental health among Women 
One objective of the study was to find out how selected demographic characteristics 
influence women‟s mental health. Contrary to earlier findings (Brereton, Clinch & 
Ferreira, 2008; Fisher & Baum, 2010; Shields & Price, 2005), age, marital status, 
employment, income and number of children did not predict mental health significantly. 
This result may be due to the fact that the participants did not vary significantly in terms of 
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these demographic variables. Majority of the participants were relatively young; 18-49 
years (82.5%) with very few of them above 50 years, most of the participants were single, 
majority were low income earners (below 500 GH Cedis per month), most of them did not 
have children and there were more of them employed than those who were not. Smith et 
al. (2003) in their meta-analytic study on religiousness and depression also found out that 
demographic variables did not influence depressive symptoms.  Some studies also did not 
find a significant relationship between marital status and mental health (de Menil, et al., 
2012; Uecker, 2012). 
Education was found to significantly predict mental health, however not all levels of 
educational attainment contributed significantly to variation in mental health. The 
regression analysis showed that those with postgraduate education are more likely to have 
better mental health compared to those with primary or below education, all other levels of 
education compared to primary education did not significantly predict mental health. An 
additional finding is that education had a strong negative relationship with mental illness. 
These findings confirm studies which found education to have a positive relationship with 
various mental health outcomes (Cooper, McCausland & Theodossiou, 2008;de Menil et 
al., 2012; Ellison et al., 2001; WHO, ICPE, 2000).  
It has been suggested that cognitive ability influences the relationship between educational 
attainment and health outcomes, in that cognitive ability influences academic performance 
hence individuals with higher cognitive abilities for learning and problem solving are 
more likely to attain higher education. Such individuals are also more likely to have the 
ability to take good care of their health through the ability to better understand health 
promoting messages and implement them, thereby enhancing their overall health and 
preventing health problems such as mental illness (Chandola et al., 2006). 
 
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Does History of Mental illness make any Difference? 
The study also sought to find out whether religiosity, social support and social negativity 
have the same or similar effects on women with mental illness as those who do not have 
any history of mental illness. Results reveal that participants with mental illness and those 
with no history of mental illness did not differ significantly on their levels of religiosity, 
social support and social negativity. History of mental illness had a direct negative 
relationship with psychological well-being, a direct positive relationship with 
psychological distress and predicted a significant reduction in overall mental health; as 
expected. It however did not moderate the relationship between religiosity, social 
negativity and mental health. This implies that the influence of religiosity and social 
negativity on mental health is the same in both groups. The results demonstrate that 
history of mental illness does not interfere significantly with women‟s religiosity and 
social relationships, hence does not affect their influence on mental health. 
 
The Relative Importance of the Influence of Religiosity over Social Relationships on 
Psychological Well-Being of Women 
Findings from the analyses revealed that social support did not have a significant 
relationship on psychological well-being, hence did not predict mental health, both 
religiosity and social negativity were found to predict psychological well-being 
significantly but religiosity was found to account for more variance in psychological well-
being than social negativity. Religiosity was therefore found to be the best predictor of 
psychological well-being among women in Accra. 
This finding may be due to the fact that religiosity can be seen as part of the self-identity 
or individuality of Ghanaians (Dein, Cook & Koenig, 2012), so individuals are 
happy/satisfied to be religious or have strong religious faith while social relationships are 
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external to the individual and part of their social identity (although social relationships are 
also central to African cultural values) hence religiosity will be more important to the 
individual‟s psychological well-being compared to social relationships. This also confirms 
Dein et al.‟s (2012) assertion that spiritual health among collectivist cultures strongly 
reflects mental health outcomes. The sample in the present study reported very high levels 
of religiosity which reflects how much religiosity is considered as part of their self 
identity. Moreover, it has been indicated that in cultures in which general levels of 
religiosity is higher at the societal level, the association between religiosity and 
psychological well-being is greater (Lavric & Flere, 2008). 
 
5.3 Limitations 
The use of cross-sectional design does not permit inferences about causal relationships 
among the variables. Due to stigma against mental illness in the Ghanaian society, many 
women were reluctant to take part in the study or disclose any history of mental illness; 
this problem was however mitigated by using a screening test to screen for history of 
mental illness. The sample used are relatively young and urbanized, it is therefore difficult 
to generalize findings to older and rural populations. Though religiosity was found to have 
a significant relationship with mental health in the present study, religiosity is a 
multidimensional construct (Greene & Elliot, 2010), and therefore the unidimensional 
nature of the religiosity measure used in this study may not have uncovered the complex 
nature of religiosity and its influence on mental health. Despite the limitations, the study 
makes important revelations about the role of religiosity, social relationships, and 
demographic variables in explaining mental health among women and set the pace for 
more research in this area. 
 
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5.4 Recommendations 
The research found out that religiosity influences mental health of women positively and 
that the quality of women‟s social interactions is also very relevant to their mental health, 
hence mental health professionals should consider encouraging women to improve their 
religiosity and the quality of their social interactions as part of prevention programs at the 
community level to promote mental health among women. African cultural values such as, 
brotherhood, humanity, mutual help and respect should also be strengthened in order to 
improve the quality of social relationships, since the perception of frequent negative 
interactions in relationships affect mental health negatively. It was also found out that 
stress significantly predicted mental health and the relationship between them was 
negative thus the higher a woman‟s level of perceived stress, the poorer her mental health. 
Stress also moderated the relationship between religiosity and mental health. It is 
recommended therefore that stress management programs be instituted for women in 
Accra. 
The findings also revealed that religious service attendance did not have significant 
influence on mental health but strength of religious faith had positive influence on mental 
health, women should therefore not just focus on religious service attendance, but they 
should strengthen aspects of their religious faith such as frequency of prayer, relationship 
with God, and the use of religion as a source of inspiration and comfort in order to 
improve their mental health. 
Since mental health is found to be negatively correlated with mental illness, improving 
mental health through enhancing religiosity, the quality of social interactions and stress 
management will therefore improve recovery from mental illness. Mental health 
professionals should also include aspects of client‟s religious faith in developing treatment 
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regime for women. Interpersonal therapy may also be beneficial for women with mental 
health problems since it would help reduce the impact of negative interactions in their 
social relationships. 
Another finding which is relevant to policy makers is that, attainment of higher education 
predicts mental health status among women and has an inverse relationship with mental 
illness. There is therefore the need for steps to be taken to address the educational needs of 
women such as sponsoring women to undertake postgraduate programs so as to promote 
their mental health and reduce the prevalence of mental disorders. Public education about 
the importance of attainment of higher education is also needed in order to encourage 
more women to attain higher levels of education. 
The influence of religiosity, social interactions and demographic variables found in the 
present study may not be peculiar to women in Accra. Future research should therefore 
extend the research to include men; in order to make comparisons between the two groups. 
Future research should also include rural and older populations in order to generalize 
findings to these populations.  
Finally, even though a relationship was found between religiosity, social negativity and 
mental health, the mechanisms underlying the relationships are inferred from theories and 
earlier research. The mechanisms specific to the Ghanaian culture is yet to be unfolded. 
Future research should therefore explore and clarify the specific mechanisms involved in 
the relationship between religiosity, social relationships and mental health among 
Ghanaians through qualitative studies. For instance, qualitative research should try 
unveiling the specific ways in which religious faith affects the daily living of these 
women, which may be beneficial to their mental health. The question about whether the 
use of religious faith among women in Ghana is different from other cultures could also be 
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addressed through qualitative research. Also through qualitative studies, the peculiar 
characteristics of social relationship among women in the Ghanaian culture would be 
unraveled. 
5.5 Conclusion 
The study sought to find out the influence of religiosity, social support, social negativity 
and selected demographic variables on mental health. Using two hundred (200) women 
residing in Accra, several hypotheses were tested. The findings of the study revealed that 
religiosity (strength of religious faith) had significant relationships with mental health 
outcomes (psychological well-being, psychological distress and mental health index), 
social support did not correlate significantly with mental health outcomes but social 
negativity had significant negative effects on mental health outcomes. Stress predicted 
mental health significantly and also moderated the relationship between religiosity and 
mental health. Mental illness did not influence the relationship between religiosity, social 
negativity and mental health. Among the demographic variables, only education predicted 
mental health significantly.  
The findings therefore imply that the important socio-demographic correlates of mental 
health among women in Accra in this study are; religiosity, social negativity, perceived 
stress and education. These factors are therefore important factors to consider when 
planning interventions in terms of promoting mental health and reducing the prevalence of 
mental illness among women at the community level. There is also the need for further 
research into the mechanisms involved in these relationships. In addition, further research 
should be carried out on different populations in order to generalize findings to a wider 
population. 
 
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REFERENCES 
Abdel-Khalek, A. M. (2009). Religiosity, subjective well-being and depression in Saudi 
children and adolescents. Mental Health, Religiosity & Culture, 12(8), 803-815.DOI: 
10.1080/13674670903006755. 
Abdel-Khalek, A. M. (2011). Religiosity, subjective well-being, self-esteem and anxiety 
among Kuwaiti Muslim adolescents. Mental Health, Religion & Culture, 14(2), 129-
140. DOI: 10.1080/13674670903540951. 
Accra Metropolitan Assembly. (2011). The Composite Budget of the Accra Metropolitan 
Assembly for the 2012 Fiscal Year. Accra: AMA.   
Akpalu, B., Lund, C., Doku, V., Ofori-Atta, A., Osei, A., Ae-Ngibise…&the MHAPP 
Research Programme Consortium. (2010). Scaling up community-based services and 
improving quality of care in the state psychiatric hospitals: the way forward for 
Ghana. African Journal of Psychiatry, 13(2), 109-115. 
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental 
disorders (3rded.). Washington, DC: Author. 
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental 
disorders       (4thed.). Washington, DC: Author. 
Asare, J. B. (2003). Mental Health Profile (Ghana). World Health Organization African 
Region: Ghana. 
Baker, P. & Cruickshank, J. (2009). I am happy in my faith: The influence of religious 
affiliation, saliency and practice on depressive symptoms and treatment preference. 
Mental Health, Religion & Culture, 12(4), 339-357. 
 Barbee, A. P., Derlega, V. J., Sherburne, S. P. & Grimshaw, A. (1998). Helpful and 
unhelpful forms of social support for HIV-positive individuals. In Derlega, V. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
81 
 
J&Barbee, A. P. (Eds.), HIV and social interaction (pp. 83-105).Thousand Oaks, 
CA: Sage. 
Barker, C. B. & Pistrang, N. (2002). Psychotherapy and social support: Integrating 
research on psychological helping. Clinical Psychology Review, 22(3), 361-379.  
Beit-Hallahmi, B. & Argyle, M. (1997). The Psychology of religious behavior, belief & 
experience. New York: Routledge. 
Belgrave, F. Z., & Allison, K.W. (2010). Introduction to African American Psychology. 
African American Psychology: from Africa to America (2nd ed). California: 
Thousands Oak. 
Belle, D. & Doucet, J. (2003). Poverty, inequality and discrimination as sources of 
depression among U.S women. Psychology of Women Quarterly, 27, 101-113. 
Bengston, V. L. & Dowd, J. J. (1980). Sociological functionalism, exchange theory and 
life cycle analysis: A call for more explicit theoretical bridges. International Journal 
of Aging and Human Development, 12, 55-73. 
Bertera, E. M. (2005). Mental Health in U.S adults: the role of the positive social support 
and social negativity in personal relationships. Journal of social and personal 
relationships, 22(1), 33-48.DOI: 10.1177/0265407505049320. 
Bhana A., Petersen, I., Baillie, K. L., Flisher, A.J., & Consortium TMRP. (2010). 
Implementing the World Health Report 2001 recommendations for integrating 
mental health into primary health care: a situation analysis of three African 
countries: Ghana, South Africa and Uganda. International Review of Psychiatry, 
22(6), 599-610. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
82 
 
Bonelli, R. M., Koenig, H. G. (2013). Mental disorders, religion and spirituality 1990 to 
2010: a systematic evidence-based review. Journal of religion and health, 52(2), 
657-673.DOI 10.1007/s10943-013-9691-4. 
Brereton, F., Clinch, J. P., Ferreira, S. (2008). Employment and Life-Satisfaction: Insights 
from Ireland. The Economic and Social Review, 39(3), 207-234. 
Buunk, B. P. & Hoorens, V. (1992). Social support and stress: The role of social 
comparison and social exchange processes. British Journal of Clinical Psychology, 
31, 445-457. 
Call, R. A., & Heaton, T. B. (1997). Religious Influence on Marital Stability. Journal for 
the Scientific Study of Religion 36, 382-92. 
Carroll, J. F. & McGinley, J. J. (2001). A screening Form for identifying Mental Health 
Problems in Alcohol/other Drug Dependent persons. Alcoholism Treatment 
Quarterly, 19(4), 33-47. 
Carroll, J. F. X., & McGinley, J. (2000). Guidelines for using the Mental Health Screening 
Form–III. Unpublished manuscript. 
Cecil, H., Stanley, M. A., Carrion, P. G. & Swann, A. (1995). Psychometric properties of 
the MPSS and NOS in psychiatric outpatients. Journal of Clinical Psychology, 51, 
593-602. 
Chandola, T., Clarke, P., Morris, J. N. & Blane, D. (2006). Pathways between education 
and health: A causal modeling approach. Journal of the Royal Statistical Society, 
169(2), 337-359. 
Clara I., Cox B., Enns M., Murray L., Torgrude L. (2003). Confirmatory factor analysis of 
the multidimensional scale of perceived social support in clinically distressed and 
student samples. Journal of Personality and Assessment, 81, 265-70. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
83 
 
Cohen, S. & Janick-Deverts, D. (2009). Can We Improve Our Physical Health by Altering 
Our Social Networks? Physical health and social networks: Perspectives on 
Psychological Science, 4(4), 375-378. 
 Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the 
United States. InSpacapam, S. &Oskamp, S. (Eds.),The social psychology of health: 
Claremont Symposium on applied social psychology. Newbury Park, CA: Sage. 
Cooper, D., McCausland, W. D. & Theodossiou, I. (2008). Unemployed, uneducated and 
sick: The effects of socio-economic status on health duration in the European Union. 
Journal of Royal Statistical Society, 171(4), 939-952. 
Cruz, M. Pincus, H. A., Welsh, D. E., Greenwald, D., Lasky, E. & Kilbourne, A. M. 
(2010). The Relationship between Religious Involvement and Clinical Status of 
Patients with Bipolar disorder. Bipolar Disorders, 12, 68-76. 
Davies, A. R., Sherbourne, C. D., Peterson, J. R. & Ware, J. E. (1998). Scoring manual: 
Adult health status and patient satisfaction measures used in RAND’s Health 
Insurance Experiment. Santa Monica: Rand Corporation. 
De Menil, V.,Osei, A., Douptcheva, N., Hill, A.G., Yaro, P. & De-Graft Aikins A. (2012). 
Symptoms of Common Mental Disorders and Their Correlates among women in 
Accra, Ghana: A population-based survey. Ghana Medical Journal, 46(2), 95-103. 
Dein, S., Cook, C. H. &Koenig, H. (2012). Religion, spirituality, and mental health: 
current controversies and future directions. The Journal of nervous and mental 
disease, 200(10), 852-855.  
Donald, P. & Montgomery, P. R. (2009). Marital status, Partner satisfaction and Depressive 
symptoms in older men and women. Canadian Journal of Psychiatry 54(7), 487-
492. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
84 
 
Ellis, A. (2000). Can rational emotive behavior therapy (REBT) be effectively used with 
people who have devout beliefs in God and religion? Professional Psychology: 
Research and Practice, 31(1), 29-33. 
Ellison C. G.& Levin S. J. (1998). The religion-health connection: evidence, theory, and 
future directions. Health Education & Behavior, 25, 700–720. 
Ellison, C. G. (1994). Religion, the Life Stress Paradigm, and the Study of Depression in 
Religion. In Levin, J. S. (Ed.),Aging and Health: Theoretical Foundations and 
Methodological Frontiers (pp. 78-121). London: Sage 
Ellison, C. G., Boardman, J. D. Williams, D. R. &Jackson, J. S. (2001). Religious 
Involvement, Stress, and Mental Health: Findings from the 1995 Detroit Area Study. 
Social Forces, 80(1), 215-249. 
Ellison, C.G. (1991). Religious Involvement and subjective well-being. Journal of Health 
and social Behavior, 32, 80-99. 
Ellison, C.G., Finch, B.K., Ryan, D.N. & Salinas, J.J. (2009). Religious involvement and 
Depressive Symptoms among Mexican-origin adults in California. Journal of 
Community Psychology, 37(2), 171-193. 
Field, A. (2009). Discovering Statistics using SPSS (3rded.). London: Sage publications 
Ltd. 
Finch, J. F. (1998). Social undermining, social satisfaction and affect: A domain-specific 
lagged effects model. Journal of Personality, 66, 315-334. 
Finch, J.F., Okun, M.A, Pool, G.J. & Ruehlman, L.S. (1999). A comparison of the 
influence of conflictual and supportive social interactions on Psychological distress. 
Journal of Personality, 67, 581-622. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
85 
 
Fisher, M. & Baum, F. (2010). The social determinants of mental health: implications for 
research and health promotion. The Australian and New Zealand journal of 
psychiatry, 44(12),1057-1063. 
Flannelly, K., Ellison, C. & Strock, A. (2004). Methodologic issues in Research on 
Religion and Health. Southern Medical Journal, 97(12), 1231-1241. 
Flett, G. L., Hewitt, P. L., Garshowitz, M. & Martin, T. R. (1997). Personality, Negative 
Social Interactions, and Depressive Symptoms. Canadian Journal of Behavioural 
Science, 29(1), 28-37. 
Florian, V. & Dory, Y. (1990). Mental Health Inventory (MHI): Psychometric Properties 
and normative data in the Israeli population. Psychologia: Israel Journal of 
Psychology, 2, 26-35. 
Fournier, O.A. (2011). The states of Mental Health Care in Ghana, West Africa and signs 
of progress in the Greater Accra Region. Berkely Undergraduate Journal, 24(3), 8-
34.http://escholarship.org/uc/item/0gp004t3. 
Gardner, J. & Oswald, A. J. (2006). Money and mental wellbeing: A longitudinal study of 
medium-sized lottery wins. Journal of health economics. 
doi:10.1016/j.jhealeco.2006.08.004. 
Grasmick, H. G., Bursik, R. J. & Cochran, J. K. (1991). Render unto Caesar What Is 
Caesar's: Religiosity and Taxpayers' Inclinations to Cheat. Sociological Quarterly, 
32, 251- 66. 
Green, M. & Elliot, M. (2010). Religion, Health and Psychological well-being. Journal of 
Religion and Health, 49, 149-163. DOI 10.1007/s10943-009-9242-1. 
Gupta, S., Avasthi, A. &Kumar, S. (2011). Relationship between religiosity and 
psychopathology in patients with depression. Indian Journal of Psychiatry, 53, 330-
335. DOI:10.4103/0019-5545.91907. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
86 
 
Gyekye, K. (1996). African Cultural Values: An Introduction. Accra: Sankofa publishing 
company. 
Hall, D. E., Meador, K. G. & Koenig, H. G. (2008). Measuring Religiousness in and 
Health Research. Journal of Religion & Health, 47, 134-183. 
Harpham, T., Snoxell, S., Grant, E. & Rodriguez, C. (2005).Common mental disorders in 
a young urban population in Colombia. British Journal of Psychiatry, 187, 161-167. 
Hogan, B., Linden, W. & Najarian, B. (2002). Social support interventions: Do they work? 
Clinical Psychology Review, 22(3), 381-440. 
Ingersoll-Dayton, B., Morgan, D. & Antonucci, T. (1997). The effects of positive and 
negative social exchanges on Aging adults. Journal of Gerontology B: Psychological 
Science and Social Sciences, 52, 190-199. 
Ismail, Z. & Desmukh, S. (2012). Religiosity and psychological well-being. International 
journal of Business and Social science, 3(11), 20-28. 
Israel, B. A., Farquhar, S. A., Schulz, A. J., James, S. A. &Parker, E. A. (2002). Health, 
Education and Behavior, 29(3), 342-360. 
James, A. &Wells, A. (2003). Religion and mental health: towards a cognitive-behavioural 
framework. British journal of health psychology, 8(3), 359-376. 
Jansen, K. L., Motley, R. & Hovey, J. (2010). Anxiety, Depression and Students‟ 
Religiosity. Mental Health, Religion & Culture, 13(3), 267-271. 
Jasinskaja-Lahti, I., Liebkind, K., Jaakkola, M. & Reuter, A. (2006). Journal of Cross-
cultural Psychology, 37(3), 292-311. 
Joon Jang, S. & Johnson, B. R. (2004). Explaining Religious Effects on Distress among 
African Americans. Journal for the scientific study of religion, 43(2), 239-260. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
87 
 
Joshi, S., Kumari, S. & Jain, M. (2008). Religious Belief and Its Relation to Psychological 
Well-being. Journal of the Indian Academy of Applied Psychology, 34(2), 345-354. 
Kawachi, J. & Berkman, L. F. (2001). Social ties and Mental Health. Journal of Urban 
Health, 78, 458-467. 
Keeton, C.P., Perry-Jenkins, M., & Sayer, A.G. (2008). Sense of control predicts 
depressive and anxious symptoms across the transition to parenthood. Journal of 
Family Psychology, 22(2), 212–221. 
Keyes, C.L. (2002). The mental health continuum: From Languishing to Flourishing in 
Life. Journal of Health and Social Behavior, 43(2), 207-222. 
Kilbourne, B. &Richardson, J.T. (1984). Psychotherapy and New Religions in a Pluralistic 
Society. American Psychologist, 39, 237-251. 
Kim, H. K. & Mckenry, P. C. (2002). The Relationship between Marriage and 
Psychological Well-being: A Longitudinal Analysis. Journal of Family issues, 23(8), 
885-911. 
Kim, J., Han, J. Shaw, Y. Mctavish, B. F. & Gustafson, D. (2010). The Roles of social 
support and coping in Predicting Breast Cancer Patients‟ Emotional Well-being. 
Journal of Health Psychology, 15(4), 543-552. 
Koenig, H. G. (2012). Religion, Spirituality, and Health: The Research and Clinical 
Implications. International Scholarly Research Network Psychiatry, 2012, 1-33. 
DOI:10.5402/2012/278730. 
Lakey, B., & Cohen, S. (2000). Social support theory and measurement. In S. Cohen, L. 
Underwood, & B. Gottlieb (Eds.), Measuring and intervening in social support. New 
York: Oxford University Press 
University of Ghana          http://ugspace.ug.edu.gh
 
 
88 
 
Laurencelle, R. M., Abell, S. C. & Schwartz, D. J. (2002). The relation between intrinsic 
religious faith and psychological well-being. International Journal for the 
Psychology of Religion, 12, 109-123. 
Lavrič, M., &Flere, S. (2008). The Role of Culture in the Relationship between Religiosity 
and Psychological Well-being. Journal of Religion and Health, 47(2), 164-175.  
Lazarus, R. S. (1966). Psychological Stress and the Coping process. New York: McGraw-
Hill. 
Lazarus, R.S. & Folkman, S. (1984). Stress, Appraisal and Coping. New York: Springer 
Publishing Company. 
Lee, E. (2012). Review of the Psychometric Evidence of the Perceived Stress Scale. Asian 
Nursing Research, 6(4), 121-127. 
Levin, J.S., Chatters, L.M. & Taylor, R.J. (1995). Religious effects on health status and 
life satisfaction among Black Americans. Journal of Gerontology: social sciences, 
50, 154-163. 
Lincoln, K. D. (2000). Social Support, Negative Social Interactions, and Psychological 
Well-Being. Social service review, 74(2),231-252. 
Lincoln, K. D., Chatters, L. M., Taylor, R. J. (2005). Social Support, Traumatic Events, 
and Depressive Symptoms among African Americans. Journal of Marriage and 
Family, 67(3), 754-766. 
Link, B. G. & Phelan, J. C. (1999). Public conceptions of mental illness: Labels, causes, 
dangerousness and social distance. American Journal of public Health, 89, 1328-
1333. 
Lowe, S. R., Chan, C. S. & Rhodes, J. E. (2010). Pre-Hurricane Perceived Social support 
protects against Psychological Distress: A longitudinal Analysis of Low-income 
University of Ghana          http://ugspace.ug.edu.gh
 
 
89 
 
Mothers. Journal of Consulting and Clinical Psychology, 78(4), 551-560.DOI: 
10.1037/a0018317. 
Lundy, J. J.,Coons, S. J., Wendel, C., Hornbrook, M. C.,Herrinton, L., Grant, M. & 
Krouse, R. S. Exploring Household Income as a Predictor of Psychological Well-
Being among Long-Term Colorectal Cancer Survivors. Quality of Life Research, 
18(2), 157-161.DOI: I 10.10 07/s1 1 1 3 6-008-9432-4 
Lyons, A.C. & Yilmazer, T. (2005). Health and financial strain: Evidence from the survey 
of consumer finances.  Southern Economics Journal. 71(4), 873-890. 
Matthews, D. A., McCullough, M.E., Larson, D.B., Koenig, H.G., Swyers, J.P, &. Milano, 
M.G. (1998). Religious commitment and health status: a review of the research and 
implications for family medicine. Archive of Family Medicine, 7(2), 118-124. 
McCullough, M. E., Hoyt, W.T., Larson, D.B., Koenig, H.G., & Thoresen, C. (2000), 
Religious involvement and mortality: a meta-analytic review. Health Psychology, 
19(3), 211-222. 
Mikulincer, M., & Shaver, P. R. (2008). An attachment perspective on bereavement. In M. 
Stroebe, R. O. Hansson, H. A. W. Schut, & W. Stroebe (Eds.), Handbook of 
bereavement research and practice: 21st century perspectives (pp. 87-
110).Washington, DC: American Psychological Association.  
Miller, K., & Ray, E. B. (1994). Beyond the ties that bind: Exploring the “meaning” of 
supportive messages and relationships. In B. R. Burleson, T. L. Albrecht, & I. G. 
Sarason (Eds.), Communication of social support: Messages, interactions, 
relationships, and community (pp. 215–228).Thousand Oaks, CA: Sage. 
Mirowsky, J. & Ross, C. E. (1992). Age and depression. Journal of Health and Social 
Behavior, 33, 187-205. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
90 
 
Moreira-Almeida, A., Lotufo Neto, F. & Koenig, H. G. (2006). Religiousness and Mental 
Health: A review. In Rev. Bras Psiquiatr (Ed.),Religiosidade esaude mental: uma 
Revisao, 28(3), 242-250. 
Murray, J. L. & Lopez, A. D. (1996). The global burden of disease: A comprehensive 
assessment of mortality and disability from diseases, injuries and risk factors in 
1990 and projected to 2020: Summary. Boston: Harvard School of Public Health, 
World Health Organization. 
Nooney, J. & Woodrum, E. (2002). Religious coping and Church-Based Social support as 
predictors of Mental Health outcome: Testing a conceptual Model. Journal for the 
Scientific Study of Religion, 41(2),359-368. 
Noor, N. M. (2008). Work and women‟s well-being, Religion and age as Moderators. 
Journal of Religion and Health, 47, 476-490. 
Ofori-Atta, A., Cooper, S., Akpalu, B., Osei, A., Doku, V., Lund, C., Flisher A. & 
MHAPP (2010). Common Understandings of women‟s mental illness in Ghana: 
Results from a qualitative study. International Review of Psychiatry, 22(6), 589-598. 
Olson, J. M., Roese, N. J. & Zanna, M. P. (1996). Expectancies. In Higgins, E. T. 
&Kruglanski, A. W. (Eds.), Social Psychology: Handbook of basic principles (pp. 
211-238). New York: Guilford Press. 
Osei, A. (2008). Pass the mental health bill now. Chief Psychiatrist of the Ghana Health 
Service. Daily Graphic; Ghana. 
Pargament, K.  I. (1997). The Psychology of Religion and Coping. New York: Guilford 
press. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
91 
 
Pargament, K. I., Smith, B.W., Koenig, H. G. & Perez, L. (1998). Patterns of positive and 
negative religious coping with major life stressors. Journal for the Scientific Study of 
Religion, 37, 710-724. 
Pargament, K. I., & Brant C. R. (1998). Religion and Coping. In Koenig, H.G. (Ed.), 
Handbook of religion and mental health. London: Academic Press. 
Pargament, K.I., Ensing, D. S., Falgout, K., Olsen, H., Reilly, B., Van Haitsma, K. et al. 
(1990). God help me (1): religious Coping efforts as predictors of the outcomes of 
significant negative life events. American journal of Community Psychology, 18, 
793-824. 
Patel, V., Araya, R., de Lima, M., Ludermir, A. & Todd, C. (1999). Women, poverty and 
common mental disorders in four restructuring societies. Social Science & Medicine, 
11, 1461-1471. 
Pearce, L. D., & Axim, W. G. (1998). The Impact of Family Religious Life on the Quality 
of Mother-Child Relations. American Sociological Review, 63, 810-828. 
Philips (III), R. E.&Stein, C. H. (2007). God‟s will, God‟s Punishment or God‟s 
Limitations? Religious Coping strategies Reported by Young Adults living with 
Serious Mental illness. Journal of Clinical Psychology, 63, 529-540. 
Piccinelli, M. & Wilkinson, G. (2000). Gender differences in depression: Critical review. 
British Journal of Psychiatry, 177, 486-492. 
Pickens, J., Field, T., Prodromidis, M., Pelaez-Nogueras, M. & Hossain, Z. (1995). 
Posttraumatic Stress, Depression and Social support among College students after 
Hurricane Andrew. Journal of College student Development, 36(2), 152-161. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
92 
 
Pierce G. R., Sarason, B. R. & Sarason, I. G. (1992). General and specific support 
expectations and stress as predictors of supportiveness: An experimental study. 
Journal of personality & Social Psychology, 63, 297-307. 
Pierce, T., Baldwin, M.W. & Lydon, J.E. (1997). A Relational Schema Approach to Social 
support. In Pierce, G.R., Lakey, B., Sarason, G. I. & Sarason, B. R. (Eds). 
Sourcebook of social support and personality (pp.19-47).New York: Plenum press. 
Plakas, S., Boudioni, M., Fouka, G., &Taket, A. (2011). The role of religiosity as a coping 
resource for relatives of critically ill patients in Greece. Contemporary Nurse, 39(1), 
95-105. 
Plante, T. G. & Boccaccini, M. (1997). Reliability and validity of the Santa Clara Strength 
of Religious Faith Questionnaire. Pastoral Psychology, 45(6), 429-437. 
Plante, T. G. (2010). The Santa Clara Strength of Religious Faith Questionnaire: 
Assessing Faith Engagement in a Brief and Nondenominational Manner. Pastoral 
Psychology, 1(1), 3-8. 
Plante, T.G., & Boccaccini, M. (1997). The Santa Clara Strength of Religious Faith 
Questionnaire. Pastoral Psychology, 45(6), 375-387. 
Prince, Patel, P. M., Saxena, S., Maj, M., Maselko, J., Philips, M. R. &Rahman, A. (2007). 
Global mental health: no health without mental health. The Lancet, 370, 859-877. 
Reinhardt, J.P. (2001). Effects of positive and negative support received and provided on 
adaptation to chronic visual impairment. Applied Developmental Science, 5, 76-77. 
Reinhardt, J.P. (2001). Social support and well-being in later life: Studying the negative 
with the positive. Applied Developmental Science, 5, 66-67. 
Robbins, S. P., Chatterjee, P. & Canda, E. R. (1998). Contemporary human behavior 
theory: A critical perspective for social work. Needham Heights, M. A: Allyn & 
Bacon.  
University of Ghana          http://ugspace.ug.edu.gh
 
 
93 
 
Rook, K.S. (1984). The negative side of social interaction. Journal of Personality and 
Social Psychology, 46, 1097-1108. 
Rosmarin, D. H., Pargament, K. I. & Mahoney, A. (2009). The role of religiousness in 
Anxiety, Depression and Happiness in a Jewish Community Sample: A preliminary 
investigation. Mental Health, Religion & Culture, 12(2), 97-113. 
Ross, C., Mirowsky, J. & Goldsteen, K. (1990). The impact of the family on health: The 
decade in review. Journal of Marriage and the Family, 52, 1059-1078.  
Ryff, C. D. & Keyes, C. L. M. (1995). The structure of Psychological Well-being 
Revisited. Journal of Personality and Social Psychology, 69, 719-727. 
Sacks, S., Melnick, G., Coen, C., Banks, S., Friedmann, P. D., Grella, C., et al. (2007). 
CJDATS co-occurring disorders screening instrument for mental disorders: A 
validation study. Criminal Justice and Behavior, 34, 1198-1215. 
Schuster, T.L., Kessler, R. C. &Aseltine, R. H. Jr. (1990). Supportive interactions, 
negative interactions and depressive mood. American Journal of Community 
Psychology, 18, 423-438. 
Shields, M. A. & Price, S. W. (2005). Exploring the economic and social determinants of 
psychological well-being and perceived social support in England. Journal of the 
Royal Statistical Society, 168(3), 513-537. 
Sims A. (1994). Psyche-spirit as well as mind? British Journal of Psychiatry, 165(4), 441-
446. 
Sleek, S. (1994). Spiritual problems included in DSM-IV. The APA monitor, 25(6), 8. 
Smith, C. (2003). Theorizing religious effects among American adolescents. Journal for 
the Scientific Study of Religion, 42, 17–30. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
94 
 
Smith, T. B., McCullough, M. E., & Poll, J. (2003). Religiousness and Depression: 
Evidence for Main effect and the Moderating influence of Stressful Life events. 
Psychological Bulletin, 129(4), 614-636. 
Southwick S. M., Vythilingam, M. &Charney, D. S. (2005). The psychobiology of 
depression and resilience to stress: implications for prevention and treatment. Annual 
Review Clinical Psychology, 2005(1), 255-259. 
Suhail, K. & Chaudhry, H. R. (2004). Predictors of Subjective Well-being in an Eastern 
Muslim Culture. Journal of Social and Clinical Psychology, 23, 359-375. 
Tabak, Melanie A., Kristin D. &Mickelson. (2009). “Religious Service Attendance and 
Distress: The Moderating Role of Stressful Life Events and Race/Ethnicity.” 
Sociology of Religion 70(1), 59–64. 
Taylor, N. M. (2001). Utilizing Religious Schemas to cope with Mental illness. Journal of 
Religion and Health, 40(3), 383-388.  
Taylor, S. E. (2009). Health Psychology (7thed.).New York: McGraw-Hill. 
Torgrud, L. J., Walker, J. R., Murray, L., Cox, B. J., Chartier, M. & Kjernisted, K. D. 
(2004). Deficits in perceived social support associated with generalized social 
phobia. Cognitive Behavior Therapy, 33, 87-96. 
Trevino, K. M., Archambault, E., Schuster, J., Richardson, P. & Moye, J. (2012). 
Religious Coping and Psychological Distress in Military veteran Cancer Survivors. 
Journal of Religion and Health, 51(1), 87-98. 
Turner, R. J. & Marino, F. (1994). Social support and social structure: A descriptive 
epidemiology. Journalof Health and Social Behavior, 35, 195–212. 
Uchino, B. N., Cacioppo, J.T. & Kiecolt-Glaser, J.K. (1996). The relationship between 
social support and physical processes. American Psychologist, 51, 13-21. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
95 
 
Uecker, J. E. (2012). Marriage and Mental Health among Young Adults. Journal of Health 
and Social Behavior, 53(1), 67-83. 
Umberson, D. & Montez, J. K. (2010). Social relationships and Health: A Flashpoint for 
Health policy. Journal of Health and Social Behavior, 51, 54-66. 
Vangelisti, A. L. (2009). Challenges in Conceptualizing Social support. Journal of Social 
and Personal Relationships, 26(1), 39-51. 
Veit, C.T. & Ware, Jnr, J.E. (1983). The structure of psychological distress and well-being 
in general populations. Journal of Consulting and Clinical Psychology, 51, 730-742. 
Vilchinsky, N. & Kravetz, S. (2005). How are religious belief and behavior good for you? 
An investigation of mediators relating religion to Mental Health in a sample of 
Israeli Jewish students. Journal for the Scientific Study of Religion, 44(4), 459-471. 
Vogt, Y.A. (2007). Perceived age discrimination and mental health. Social Forces, 86(1), 
291-311.  
Walen, H. R. & Lachman, M. E. (2000). Social support and strain from partner, family and 
friends: costs and benefits for men and women in adulthood. Journal of Social and 
Personal Relationships, 17(1), 5-30. DOI: 10.1177/0265407500171001. 
Ward, A. M. (2010). The Relationship between Religiosity and Religious Coping to Stress 
Reactivity and Psychological Well-Being. Counseling and Psychological services 
dissertations: Georgia State University. 
Webb, M., Charbonneau, A.M., McCann, R. A. & Gayle, K. R. (2011). Struggling and 
Enduring with God, Religious Support and Recovery from Severe Mental illness. 
Journal of Clinical Psychology, 67(12), 1161-1176. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
96 
 
Wei, D. & Liu, E. Y. (2013). Religious Involvement and Depression: Evidence for 
Curvilinear and Stress-Moderating Effects among Young Women in Rural China. 
Journal for the Scientific Study of Religion, 52, 349–367.  
Wethington, E. & Kessler, R. C. (1986). Perceived Social support, received support and 
adjustment to stressful life events. Journal of Health and Social Behavior, 27, 78-89. 
Wethington, E. McLeod, J., & Kessler, R. C. (1987). The importance of life events for 
explaining sex differences in Psychological distress. In Barnett, R. C., Baruch, G. K. 
& Beiner, L. (Eds.), Gender and stress (vol. xii, pp. 144-154). New York: Free press. 
Whisman, M. A. (2013). Relationship discord and the prevalence, incidence, and treatment 
of psychopathology. Journal of social and personal relationships, 30(2), 163-170. 
Winefield, A. H. (2002). Unemployment, Underemployment, Occupational Stress and 
Psychological Well-Being. Australian Journal of Management, 27, 137-148. 
World Health Organization (2000). Women’s mental health: An evidence based review. 
Geneva: WHO. 
World Health Organization (2007). Ghana, a very progressive mental health law. Mental 
Improvements for Nations Development: Department of Mental Health and 
substance Abuse. Geneva: WHO. 
World Health Organization (2009). Mental health, Resilience and Inequalities. Geneva: 
WHO 
World Health Organization, International Consortium Psychiatric Epidemiology (WHO, 
ICPE). (2000). Cross-national Comparisons of the prevalence and correlates of 
mental disorders. Bulletin of the World Health Organization, 78, 413-426. 
University of Ghana          http://ugspace.ug.edu.gh
 
 
97 
 
World Health Organization. (2002). Nations for Mental Health Policy and Service 
Development: Department of Mental Health and Substance Dependence. Geneva: 
WHO. 
World Health Organization. (2003). Social determinants of health: The Solid Facts 
(2nded.). In Marcot M., Wilkinson R. G. (Eds). Denmark: The regional office for 
Europe of the World Health Organization. 
Wulff, D.M. (1997). Psychology of Religion: Classic and Contemporary (2nded.). New 
York: Wiley & Sons. 
Zhang, W. (2012). Negative Social exchanges, Acculturation-Related Factors, and Mental 
Health among Asian Americans. Journal of BSA Medsoc Group, 6(2), 12-29. 
Zimet, G.D., Powell, S.S., Farley, G.K., Werkman, S. & Berkoff, K.A. (1990). 
Psychometric characteristics of the Multidimensional Scale of Perceived Social 
Support. Journal of Personality Assessment, 55, 610-17. 
Zimet, G.D., Dahlem, N.W., Zimet, S.G. & Farley, G.K. (1988). The Multidimensional 
Scale of Perceived Social Support. Journal of Personality Assessment, 52, 30-41 
 
 
 
 
 
 
 
 
 
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APPENDICES 
APPENDIX A 
DEMOGRAPHIC QUESTIONNAIRE 
Please provide the necessary information about yourself by choosing from the options 
provided. 
1. What is your age?  
a. 18-29 
b. 30-49 
c. 50-64 
d. 65 and above   
 
2. What is the highest level of education you have attained? 
a. Primary 
b. JHS 
c. Secondary/ technical/ vocational 
d. Tertiary 
e. Postgraduate 
 
3. What is your religion? 
a. None 
b. Muslim 
c. Christian 
d. Traditional 
e. Other (please specify) 
 
4. Apart from funerals, weddings etc how many times did you happen to attend 
church, synagogue, mosque, shrine or any other religious worship service in 
the last 30 days? 
a. Once 
b. 2 to 3 times 
c. 4 times 
d. 5 times or more 
 
5. What is your estimated monthly income in Ghana Cedi? 
a. Below 500 
b. 500-2000               
c. 2000-3000                   
d. Above 3000 
 
6. What is your employment status? 
a. Formal employment 
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b. Not employed 
c. Retired 
d. Informal employment 
 
7. What is your marital status? 
a. Single/never been married 
b. Married 
c. Separated 
d. Divorced 
e. Widowed 
 
8. How many children do you have? 
a. 0 
b. 1 
c. 2 
d. 3 
e. 4 or more 
 
9. Do you have a history of mental illness/ have you ever been diagnosed with a 
mental illness? 
a. Yes  
b. No 
 
10. If yes, what was the diagnosis?  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
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APPENDIX B 
 
MENTAL HEALTH SCREENING FORM III (MHSF-III) 
Instructions 
Any information you provide to us on this form will be kept in strict confidence. It will not 
be released to any outside person or agency without your permission. If you do not know 
how to answer these questions, ask the staff member giving you this form for guidance. 
Please note, each item refers to your entire life history, not just your current situation, this 
is why each questions begins – “Have you ever…” 
 
1. Have you ever talked to a psychiatrist, psychologist, therapist, social worker, or 
counselor about an emotional problem?         
        YES  _____ NO  _____ 
 
2. Have you ever felt you needed help with your emotional problems, or have you had 
people tell you that you should get help for you emotional problems?  
YES _____ NO  _____ 
 
3. Have you ever been advised to take medication for anxiety, depression, hearing 
voices, or for any other emotional problem?      
        YES  _____ NO  _____ 
 
4. Have you ever been seen in a psychiatric emergency room or been hospitalized for 
psychiatric reasons?         
        YES  _____ NO  _____ 
 
5. Have you ever heard voices no one else could hear or seen objects or things which 
others could not see?         
        YES  _____ NO  _____ 
 
6. a)  Have you ever been depressed for weeks at a time, lost interest or pleasure in most  
activities, had trouble concentrating and making decisions, or had thought about 
killing yourself?         
       YES _____ NO _____ 
 
       b)  Did you ever attempt to kill yourself?      
        YES _____ NO  _____ 
 
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7. Have you ever had nightmares or flashbacks as a result of being involved in some 
traumatic/terrible event?  For example, warfare, gang fights, fire, domestic violence, 
rape, incest, car accident, being shot or stabbed?      
        YES  _____ NO  _____ 
 
8. Have you ever experienced any strong fears?  For example, of heights, insets, animals, 
dirt, attending social events, being in a crowd, being alone, being in places where it 
may be hard to escape or get help?       
        YES  _____ NO  _____ 
 
9. Have you ever given in to an aggressive urge or impulse, on more than one occasion 
that resulted in serious harm to others or led to the destruction of property?   
YES _____   NO _____ 
 
10. Have you ever felt that people had something against you, without them necessarily 
saying so, or that someone or some group may be trying to influence your thoughts or 
behavior?           
        YES  _____     NO  _____ 
 
11. Have you ever experienced any emotional problems associated with your sexual 
interests, your sexual activities, or your choice of sexual partner?   
        YES  _____ NO  _____ 
 
12. Was there ever a period in your life when you spent a lot of time thinking and 
worrying about gaining weight, becoming fat, or controlling your eating?  For 
example, by repeatedly dieting or fasting, engaging in a lot of exercise to compensate 
for binge eating, taking enemas, or forcing yourself to throw up?   
        YES  _____ NO  _____ 
 
13. Have you ever had a period of time when you were so full of energy and your ideas 
came very rapidly, when you talked nearly non-stop, when you moved quickly from 
one activity to another, when you needed little sleep, and believed you could do almost 
anything?           
        YES  _____   NO  _____ 
 
14. Have you ever had spells or attacks when you suddenly felt anxious, frightened, and 
uneasy to the extent that you began sweating, your heart began to beat rapidly, you 
were shaking or trembling, your stomach was upset, you felt dizzy or unsteady, as if 
you would faint?           
        YES  _____   NO  _____ 
 
15. Have you ever had a persistent, lasting thought or impulse to do something over and 
over that caused you considerable distress and interfered with normal routines, work, 
or your social relations?  Examples would include repeatedly counting things, 
checking and rechecking on things you had done, washing and rewashing your hands, 
praying, or maintaining a very rigid schedule of daily activities from which you could 
not deviate.            
        YES  _____   NO _____ 
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16. Have you ever lost considerable sums of money through gambling or had problems at 
work, in school, with your family and friends as a result of your gambling?        
 
YES _____   NO _____ 
 
17. Have you ever been told by teachers, guidance counselors, or others that you have a 
special learning problem?         
        YES  _____ NO  _____ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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APPENDIX C 
SANTA CLARA STRENGTH OF RELIGIOUS FAITH QUESTIONNAIRE 
Please answer the following questions about religious faith using the scale below. Indicate 
the level of agreement or disagreement for each statement by circling 1, 2, 3 or 4. 
1= strongly disagree 2= disagree 3= agree 4= strongly agree 
1. My religious faith is extremely important to me.                1   2    3    4 
2. I pray daily.                                                   1   2     3   4  
3. I look to my faith as a source of inspiration.                       1   2     3   4  
4. I look to my faith as providing meaning and purpose in my life. 1   2     3    4 
5. I consider myself active in my faith or church.                    1   2     3   4 
6. My faith is an important part of who I am as a person.         1   2     3    4  
7. My relationship with God is extremely important to me.       1   2     3    4 
8. I enjoy being around others who share my faith.                   1   2     3    4 
9. I look to my faith as a source of comfort.                              1   2     3     4 
10. My faith impacts many of my decisions.                                1  2     3     4  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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APPENDIX D 
 
PERCEIVED STRESS SCALE 
 
Questions in this scale ask you about your feelings and thoughts during the last month. 
In each case, you will be asked to indicate by circling how often you felt or thought a 
certain way. 
0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often 
 
1. In the last month, how often have you been upset because of something that happened 
unexpectedly?        0  1  2  3  4 
2. In the last month, how often have you felt that you were unable to control the important 
things in your life?        0  1  2  3  4 
3. In the last month, how often have you felt nervous and “stressed”?  0 1  2  3  4 
4. In the last month, how often have you felt confident about your ability to handle your 
personal problems?        0  1  2  3  4 
5. In the last month, how often have you felt that things were going your way?  
          0  1  2  3  4 
6. In the last month, how often have you found that you could not cope with all the things 
that you had to do?        0  1  2  3  4 
7. In the last month, how often have you been able to control irritations in your life?  
          0  1  2  3 4 
8. In the last month, how often have you felt that you were on top of things? 
0 1 2  3   4 
9. In the last month, how often have you been angered because of things that were outside 
of your control?        0  1  2  3  4 
10. In the last month, how often have you felt difficulties were piling up so high that you 
could not overcome them?       0  1  2  3  4 
 
 
 
 
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APPENDIX E 
SOCIAL NEGATIVITY QUESTIONNAIRE 
Please answer the following questions about your socio-emotional exchanges with your 
family, friends and significant others. Indicate the frequency of these exchanges by 
circling 1, 2, 3 or 4.    1= never 2= rarely 3= sometimes 4= often 
1. How frequently do you argue with your relatives/spouse?     1        2          3         4 
2. How often does your relatives/spouse criticize you?               1        2          3         4 
3. How often does your relatives/spouse let you down?              1        2           3        4 
4. How often do you experience excessive demands put on you by your family?  
 1       2          3        4 
5. How often does your family get on your nerves?                     1       2          3        4 
6. How often does your family make you feel tense?                   1       2          3        4 
7. How frequently do you argue with your friends?                      1      2          3        4 
8. How often do your friends criticize you?                             1      2          3         4 
9. How often do your friends let you down?                                 1      2          3         4 
10. How often do you experience excessive demands put on you by your friends?  
  1       2          3       4 
11. How often do your friends get on your nerves?                        1       2          3      4 
12. How often do your friends make you feel tense?                      1       2          3      4 
13. How frequently do you argue with significant others?             1        2         3       4 
14. How often do significant others criticize you?       1        2         3       4 
15. How often do significant others let you down?                        1        2         3       4 
16. How often do you experience excessive demands put on you by significant others?  
   1      2         3        4 
17. How often do significant others get on your nerves?                 1       2         3       4 
18. How often do significant others make you feel tense?               1       2         3       4 
Family= relatives/spouse/children 
Significant others= people outside your family and friends who play significant roles in 
your life (example neighbours, employer/employee, teacher/lecturer, colleagues etc.) 
 
 
 
 
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APPENDIX G 
CONSENT FORM 
 
Title: “Mental Health among Women in Accra: The Effects of Religiosity, Social Support 
and Social Negativity” 
Principal Investigator: Ethel Akpene Atefoe 
Principal Supervisor: Dr. Samuel Atindanbila 
Department of Psychology, University of Ghana, Legon 
 
General information about the research 
The aim of the research is to explore the various ways in which religiosity, positive and negative 
socio-emotional exchanges/interactions affect the mental health of women in Accra and to find 
out whether similar effects are found among women with mental illness and those without any 
history of mental illness. Your task will be to fill out the questionnaires given to you as truthfully 
as possible. It would take approximately 30minutes -1 hour to complete the questionnaires.  
 
Possible Risks and Discomforts 
You may experience some level of fatigue. Steps will be taken to allow for intermittent breaks in 
order to minimize fatigue. 
 
Possible Benefits  
Your participation will help to gather information concerning the roles of religiosity, socio-
emotional interactions and demographic factors in explaining mental health among women, 
which will greatly help to better understand the relationship between mental health and these 
social factors from a Ghanaian perspective. 
 
Confidentiality 
Please be assured that the information you will provide would be used only for the purpose of 
research and there is no wrong or right answer. Your cooperation is fully appreciated. You are not 
required to provide your name on any of the questionnaires or during interview, and any 
information you provide will be protected as much as possible. 
 
Compensation 
There will be no material compensation, but your participation will be very much appreciated. 
 
 
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Voluntary Participation and Right to Leave the Research 
Participation in this research is completely voluntary. You have the right to say no. You may 
change your mind at any time and withdraw. You may also choose not to answer specific 
questions or to stop participating at any time. 
 
Contacts for Additional Information 
In case of any doubt or/and for additional information concerning the study you may contact the 
Principal Investigator;Ethel A. Atefoe University of Ghana, Legon Telephone: 0203658392 or 
email address: eatefoe@gmail.com 
 
Your rights as a Participant 
This research has been reviewed and approved by the Institutional Review Board of Noguchi 
Memorial Institute for Medical Research (NMIMR-IRB).  If you have any questions about your 
rights as a research participant you can contact the IRB Office between the hours of 8am-5pm 
through the landline 0302916438 or email addresses: nirb@noguchi.mimcom.org or 
HBaidoo@noguchi.mimcom.org .   
 
 
VOLUNTEER AGREEMENT 
The above document describing the benefits and procedures for the research title (Mental Health 
among Women in Accra: The Effects of Religiosity, Social Support and Social Negativity 
among Women with Mental Illness) has been read and explained to me. I have been given an 
opportunity to have any questions about the research answered to my satisfaction. I agree to 
participate as a volunteer. 
 
_______________________ __________________________________________
  
Date                                                                             Name and signature or mark of volunteer 
 
If volunteers cannot read the form themselves, a witness must sign here: 
I was present while the benefits, risks and procedures were read to the volunteer. All questions 
were answered and the volunteer has agreed to take part in the research. 
 
________________                                       __________________________________________ 
Date                                                                               Name and signature of witness 
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I certify that the nature and purpose, the potential benefits, and possible risks associated with 
participating in this research have been explained to the above individual. 
 
_______________________                                 ______________________________________ 
Date                                            Name and Signature of Person Who Obtained Consent  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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APPENDIX J 
CONFIRMATORY FACTOR ANALYSIS FOR THE COMPONENTS OF THE 
SOCIAL NEGATIVITY QUESTIONNAIRE 
 
 
Rotated Component Matrix 
 Component 
 1 2 3 
how often do your friends get on your nerves .769   
how often do your friends criticize you .759   
how frequently do you argue with your friends .749   
how often do you experience excessive 
demands put on you by your friends 
.748   
how often do your friends make you 
tense/uneasy or nervous 
.732   
how often do your friends let you down .692   
how often do significant others get on your 
nerves 
 .792  
how often do significant others make you feel 
tense/uneasy of nervous 
 .781  
how often do you experience excessive 
demands put on you by significant others 
 .755  
how often do significant others criticize you  .742  
how often do significant others let you down  .721  
how frequently do you argue with significant 
others 
 .698  
how often does your family get on your nerves   .753 
how often do your relatives/spouse let you 
down 
  .696 
 
 
how often do your relatives/spouse say negative 
things about you or what you do 
                        .640 
how often do you experience excessive 
demands put on you by your family 
  .636 
how frequently do you argue with your 
relatives or spouse 
  .554 
how often does your family make you 
tense/uneasy or nervous 
  .528 
Extraction Method: Principal Component Analysis.  
 Rotation Method: Varimax with Kaiser Normalization. 
 
 
 
 
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APPENDIX K 
MULTIPLE REGRESSION ANALYSIS OF THE CONTRIBUTIONS OF 
RELIGIOSITY AND SOCIAL NEGATIVITY ON PSYCHOLOGICAL WELL-
BEING 
 
Predictors B SEB  t Ρ 
Religiosity .39              .11                     .24                 3.46             .001 
Social negativity                - .22              .08                   -.18                 -2.63           .009 
 
 
 
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