Academic journal article Journal of Psychology and Theology

Mental Health of Cross-Cultural Healthcare Missionaries

Academic journal article Journal of Psychology and Theology

Mental Health of Cross-Cultural Healthcare Missionaries

Article excerpt

In this study of career healthcare missionaries (N = 393), 47.9% of female missionaries and 42.1% of male missionaries reported experiencing anxiety, while 32.5% of female missionaries and 27.5% of male missionaries reported experiencing depression. For both females and males, depression severity scores showed a bimodal distribution of more and less severe depression, suggesting a clearer delineation for mild and severe depression. Regression analyses found that low role satisfaction was associated with both anxiety (p = .006) and depression severity (p = .004). A model is proposed describing the relationship between role satisfaction and its correlates: job expectations prior to arriving on the field, receptivity of the host country, gender, and imbalance of work and ministry. This model also describes the bidirectional relationship between role satisfaction and the existence of depression and/or anxiety.



There are an estimated 400,000 Christian missionaries working cross-culturally around the world--127,000 of whom are from the United States (Center for the Study of Global Christianity, 2013). Of those missionaries from North America, 42,000 are serving in assignments of four or more years (Jaffarian, 2008). A variety of healthcare professionals make up a portion of the missionary workforce, and their service in the healthcare field is done directly or indirectly in support of the spiritual purposes of their sending organization. Healthcare missionaries are the subjects of this study.

Research has shown that anxiety and moodiness are key factors impacting missionaries' job performance (Britt, 1983; Cousineau, Hall, Rosik, & Hall, 2010; Judge, Thoreson, Bono, & Patton, 2001; Rosik, Ordway, & Tafoya, 2009) and that depression affects all spheres of functioning and well-being (Lerner & Henke, 2008; Richards, 2011). Anxiety and depression exist as distinct but related psychological conditions (Clark & Watson, 1991) with comorbid anxiety present in 50% of persons with major depression (Fava et al., 1997). Although depression has been referred to as the "common cold" of psychological disorders (Koteskey, 2011), anxiety is more prevalent than depression in most populations (Kendler & Gardner, 2011). While depression is often manifested in specific symptoms such as sadness, fatigue, hopelessness, and difficulty concentrating (Lepine & Briley, 2011), anxiety is often manifested in a wider variety of symptoms that are less specific than those of depression, such as stress, obsessive compulsive symptoms, insomnia, and panic disorder (Kendler& Gardner, 2011). Because of the impact that depression and anxiety have on work performance and well-being (Cousineau et al., 2010; Lerner & Henke, 2008), investigating the mental health of healthcare missionaries is essential both for preserving their health and wellness and for safeguarding the stability of their job performance.

Those who choose to make a long-term commitment to working overseas will likely experience some distressing events including social isolation, cultural adjustment, and repatriation (Bikos & Hall, 2009; Eriksson et al., 2009; Foyle & Watson, 1998). In a review of the literature, Foyle and Watson (1998) reported a high incidence of affective and adjustment disorders among career missionaries. Based on the experience of 212 missionaries who returned to the U.K., Peppiatt and Bypass (1991) reported an incidence of depression and anxiety of 41.0 and 63.5 per 1000 person-years (i.e., number of persons observed times the number of years they were observed), respectively. Sweatman (1999) reported that first-time missionaries may be more likely to experience symptoms of depression than anxiety. As a baseline for comparison, the lifetime prevalence of depression among physicians (ages 45-54) in the U.S. is 12% of male physicians and 19.5% of female physicians (Center et al. …

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