SOCIAL SUPPORT, SELF-ESTEEM AND RELIGIOSITY AS PREDICTORS OF DEPRESSION CONTROL AMONG YOUTHS IN NIGERIA

CHAPTER TWO

LITERATURE REVIEW

INTRODUCTION

Our focus in this chapter is to critically examine relevant literatures that would assist in explaining the research problem and furthermore recognize the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps.

Precisely, the chapter will be considered in three sub-headings:

• Conceptual Framework
• Theoretical Framework

CONCEPTUAL FRAMEWORK

Depression

Depression is a significant contributor to the global burden of disease and affects people in all communities across the world. Today, depression is estimated to affect 350 million people. The World Mental Health Survey conducted in 17 countries found that on average about 1 in 20 people reported having an episode of depression in the previous year. Depressive disorders often start at a young age; they reduce people’s functioning and often are recurring. For these reasons, depression is the leading cause of disability worldwide in terms of total years lost due to disability. The demand for curbing depression and other mental health conditions is on the rise globally. A recent World Health Assembly called on the World Health Organization and its member states to take action in this direction (WHO, 2012).

Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration. Moreover, depression often comes with symptoms of anxiety. These problems can become chronic or recurrent and lead to substantial impairments in an individual’s ability to take care of his or her everyday responsibilities. At its worst, depression can lead to suicide. Almost 1 million lives are lost yearly due to suicide, which translates to 3000 suicide deaths every day. For every person who completes a suicide, 20 or more may attempt to end his or her life (WHO, 2012).

There are multiple variations of depression that a person can suffer from, with the most general distinction being depression in people who have or do not have a history of manic episodes.

• Depressive episode involves symptoms such as depressed mood, loss of interest and enjoyment, and increased fatigability. Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe. An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely. During a severe depressive episode, on the other hand, it is very unlikely that the sufferer will be able to continue with social, work, or domestic activities, except to a very limited extent.

• Bipolar affective disorder typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated mood and increased energy, resulting in over-activity, pressure of speech and decreased need for sleep. While depression is the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males (WHO, 2008). In fact, depression is the leading cause of disease burden for women in both high-income and low- and middle-income countries (WHO, 2008). Research in developing countries suggests that maternal depression may be a risk factor for poor growth in young children (Rahman et al, 2008). This risk factor could mean that maternal mental health in low-income countries may have a substantial influence on growth during childhood, with the effects of depression affecting not only this generation but also the next.

Modern Concept Of Depression

The modern concept of depression, as viewed by most psychiatrists and enshrined in the two official classifications, The ICD-10 Classification of Menial and Behavioral Disorders. Clinical descriptions and diagnostic guidelines (ICD 10) and Diagnostic and Statistical Manual of Mental Disorders. 4th ed. (DSM-IV), is essentially one of a clinical syndrome, defined by presence of a number of clinical features, but not requiring a specific etiology, and acknowledging the possibility of both psychological and biological causative factors in a somewhat Meyerian way. DSM-IV does exclude states where the symptoms are “better accounted for by bereavement,” an imprecise criterion, which is expanded by specifications of not persisting for longer than 2 months, or characterized by marked functional impairment, morbid preoccupation with worthless ness, suicidal ideation, psychotic symptoms, or psychomotor retardation. The value of this exclusion has been debated. Evidence from symptom studies indicates considerable similarities to non bereavement depression. Further studies arc still needed, particularly some which focus on the 2-month period which is crucial in the DSM-IV definition, and include investigations which ask if the picture of bereavement depressions in this period is different from other depressions, and whether they subside or continue outside this time.

This definition of depression is essentially syndromal and medical, resembling that of a syndrome in other fields of medicine. This implies a cluster of symptoms and signs which tend to occur together, which are assumed to reflect a common pathophysiology, that may not yet be understood, but may have diverse etiologies in different cases. Examples from internal medicine include the malabsorption syndrome, and congestive cardiac failure.

This is an aspect of the medical theory of diseases. In the medical concept each disease is regarded as having a specific, well defined etiology, pathology, clinical picture, and often a specific treatment. The advantages of being able to assign individuals to the correct disease have been great. Essentially, as pointed out many years ago by a philosopher, C. G. Hempcl, they involve generalization of information. Once a patient is correctly diagnosed, much additional information is available regarding such aspects as underlying mechanisms, causation, prediction of outcome, and best treatment.

A syndrome at the level indicated above does not correspond fully to a disease, since multiple causes, and therefore separate diseases, may underlie it. In psychiatry, matters are more complex and often not clear cut. Different syndromes may overlap and co-occur. Defining pure diseases by etiology has generally not succeeded, since causes often appear to be multiple, even in the single case, and not all etiological factors arc known. Nevertheless, many of the above advantages do apply to syndromal diagnoses, including assignment of appropriate treatment and prediction of outcome. It is possible that, as genes involved in psychiatric disorders become elucidated, endophenotypes reflected in underlying disturbances, and genetically defined disorders, may come to correspond more closely to true diseases.

The classical method of identifying a disorder, for most of the history of psychiatry, was for the influential psychiatrist to discern and describe disorders based on his or her clinical experience, with little attempt at precise definition or method-based research. The main method of forming diagnoses in modern psychiatric nosology has been by committee agreement, based sometimes on quite limited empirical, research. Diagnostic criteria are then defined by listing certain symptoms, to define the number necessary for the diagnosis, with duration of time, other requirements, and exclusions. In DSM-IV, eight symptoms are listed as qualifying for major depression, with a requirement that at least five be present, including at least one of two core symptoms, together with duration of 2 weeks or more, presence of clinically significant distress or impairment of function, with absence respectively of mixed episode, direct effects of a drug of abuse, a medication or other substance, or of a general medical condition, or of bereavement, and for depressive disorder, of bipolar disorder or certain other psychotic diagnoses. For dysthymia, fewer symptoms are required, but for a longer period of 2 years, and from a shorter list of eligible symptoms.

For ICD-10 depressive episode, the definitions in the clinical criteria are not tightly specified, but they are well specified in the separate Research Criteria, where they tend to be more restrictive than in the clinical criteria. The Research Criteria are less used, and the existence of two different sets of criteria in the classification causes some obvious problems. Eligible symptoms for depressive episode are the same as in DSM-IV, with the addition of one further symptom, loss of confidence or selfesteem, with the number of symptoms required to be present depending on the severity of the episode, and a third symptom, fatigue, placed as eligible with the two other core symptoms, rather than in the additional list. There is an identical minimum length, of 2 weeks, and somewhat similar excluding criteria, but without specifying bereavement. The list of eligible symptoms for dysthymia is longer, with three required

Classification Of Depression

Depressive disorders have long been recognized as heterogeneous. Their sub classification has generated as much research, and as much heat, as any controversy in psychiatry.

The two official schemes are parallel, but not identical, and neither is entirely satisfactory (Paykel ES.2002). DSM-IV is simpler. Its major categories are depressive disorders and bipolar disorders. Both have subcategories. Within depressive disorders (unipolar depression), the main concern of this paper, the major subcategories are major depressive disorder (itself divided into single episode and recurrent disorder), dysthymic disorder, and the catch-all required to make any official scheme comprehensive for all users, depressive disorder not otherwise specified. The most recent episode can be additionally specified by a set of severity/psychotic/remission specifiers; as chronic; with catatonic features; with melancholic features; with atypical features; with postpartum onset. There is also a further major category for other mood disorders, which include mood disorders due to general medical conditions and substance-induced mood disorder.

In ICD-10 the major categories are manic episode; bipolar affective disorder; depressive episode; recurrent depressive disorder; persistent mood (affective) disorders (dysthymia, cyclothymia); other mood (affective) disorders; unspecified mood (affective) disorder. The two major axes are really bipolar-unipolar, and course (single episode, recurrent, persistent). Within any depressive episode, single or recurrent, there are subcategories by severity (mild, moderate, severe without psychotic symptoms, with psychotic symptoms, in remission for recurrent disorders) and an additional specifier is available for somatic syndrome (melancholia).

DSM-III and ICD-10 represented quite major advances on their predecessors, DSM-II (rooted much more in psychoanalytic and Meyerian concepts of reaction types) and ICD-9, by their use of structured criteria and their use of modern concepts. Structured criteria were used particularly in DSM-III and successors. ICD-10 is ambiguous in this respect, with its two sets of criteria, the Research Criteria which are well defined, the clinical criteria which are not. Both classifications do also have disadvantages (Paykel ES.2002). They are complex, in their fine categories. They are not identical, and, national susceptibilities aside, would be much better fused to a single classification, employing the advantages of each, without the disadvantages, sometimes different, that each has. The strong separation into single episode and recurrent is not justified by empirical research, and it is not useful as a major division: all disorders which become recurrent are single episode on the first occasion. The DSM definitions are better. The specification in DSM-III of depressions related to medical disorder and to substance use is not helpful, since there is little to show they differ from the rest of depressions in any major ways.

Bipolar And Unipolar Disorder

Much of the discussion about the nosology of affective disorder concerns various subtypes. Depression was for many years a fertile ground for classifiers (Kendell RE and Paykel ES 1968/1981). Although much of the heat and pressure have subsided, the issues still complicate diagnostic schemes.

The best-accepted and best-substantiated distinction is the bipolar-unipolar one. This was not always so. As described above, Kraepelin viewed all affective disorders as manic-depressive. As late as ICD-9, published in 1978, the ICD did not clearly make the separation, although hidden within the subcategories of manic-depressive disorder (296) for readers of very small print, was a distinction between 296.1, manic-depressive, depressed, which was meant to be unipolar, and 296.3, manic-depressive, circular, depressed, which was meant to be bipolar. Most users of the classification did not realize this, so the distinction was in practice ver}' erratically recorded. The unipolar-bipolar distinction was incorporated into DSMIII when it was issued in 1980, and later into the ICD when ICD-10 was issued.

It was path finding work in the 1960s by Angst17 and Penis18 that established the value of the distinction. They had been influenced by descriptions by Karl Leonhard, a 20th-century German psychiatrist with a very 19th-century approach to nosology based on his mental hospital clinical experience, of monopolar and bipolar cycloid psychoses (Leonhard K 1961) The bipolar-unipolar distinction is clcarcut by definition, depending on the occurrence of a manic episode. Usually it is also so in practice, although late first manic episodes lead to embarrassing changes of diagnosis, and it is hard to be sure of the nature of minor mood elevations, in some cases which are regarded as bipolar disorder or cyclothymic disorder, or in some subjects with milder mood changes in community epidemiology studies. The status of single-episode mania is debated, but is accepted by most as indicating true bipolar disorder. Some would regard recurrent depression as related to bipolar disorder, but there is not good evidence that this is the case. TTttcrc are good validating features for the distinction.(Perris C, Goodwin FK and, Jamison KR 1990/2007). Bipolar disorder is more familial, and there is much more evidence of bipolar disorder in first-degree relatives of bipolars than in relatives of unipolars, although about half the cases of affective disorder in the relatives of bipolars are nevertheless unipolar. There is also better evidence from twin studies that the familial elevation is genetic. Molecular genetic evidence of different genes could confirm the distinction, but this evidence is not yet clearcut. There is a different sex ratio in bipolar disorder, equal or nearly so, possibly a more equal social class distribution, and some association with milder cyclothymic disorder, although the full status of more recent work on cyclothymia still requires confirmation by validating studies. Treatment response differs, with a better response to maintenance lithium and possibly to anti-convulsants, although in unipolars the evidence is not yet adequate. More manic episodes occur on antidepressants. Bipolar disorder has an earlier onset than severe unipolar disorder, and tends to be more recurrent. Onsets in women are not uncommonly postpartum, particularly in the case of mania.

The present review mainly concerns unipolar depression. There have been a number of recent reports comparing bipolar and unipolar depressions (Muzina DJ., Kemp DE., Mclntyre RS&Bowden CL 2007/2005) In addition to the history features indicated above, bipolar depressions have variously been reported to show more of the following symptom features compared with unipolar: more retardation, hypersomnia, anxiety, mood lability, psychotic features (especially when the age is under 35); less evidence of sad mood, and various somatic complaints. However, often the pictures are indistinguishable.

Psychotic Depression And Melancholia/Somatic Syndrome

The greatest controversy of a previous era concerned a dualistic theory of depression, with a dichotomy between what was variously termed psychotic or endogenous depression on the one hand, and neurotic or reactive depression on the other. Starting in the later 1920s, and throughout the 1930s, fierce debates took place, particularly in British psychiatry, between those advancing a dualistic view and those taking a unitary stance, viewing all depressions as part of a single disorder, without any clear separation into sub-types (Kendell RE 19680). The debate subsided with the greater preoccupations of World War II, and reappeared in the form of empirical studies using multivariate statistics in the 1960s (Paykel ES 1981). Terminology was confused. The term “psychotic” refers to a severe disorder with delusions and hallucinations, “neurotic” to a milder disorder without these, and often with the connotation of a vulnerable personality. “Endogenous” and “reactive” refer in this context to absence or presence of life stress. The reason for the partial fusion is that, in the fully evolved concept, there were viewed as three aspects:

1. absence of life stress;
2. presence of a clinical picture characterized by greater severity, sometimes delusions or hallucinations, diurnal variation with morning worsening, delayed insomnia with early-morning wakening, greater somatic disturbances such as loss of appetite and weight, psychomotor retardation or agitation; this was the so-called endogenous clinical picture, or what in the 1970s was termed endogenomorphic depression (Klein DF. 1971);
3. a personality, associated with reactive or neurotic depression, which was stress-vulnerable or maladaptive.

Over time, the concept of psychotic depression has become separated from that of endogenous depression. Psychotic depression has retained a secure place in the official schemes, as a variant of severe depression. It is clearly definable, by presence of delusions (particularly if mood-congruent) or hallucinations and there is validating evidence, for instance in the better response of such depressions to electroconvulsive therapy (ECT) or antipsychotic drugs, than to antidepressants alone.

Endogenous depression and its opposite arc more problematic, both regarding classificatory status and terminology. There is evidence in support. The factor-analytic and cluster- analytic studies of the 1960s and 1970s in most cases found a dimension or group (Paykel ES 1971) On detailed examination, this sometimes looks more like the psychotic element and sometimes the melancholic. However, neurotic depression did not emerge as clearly as a single group in these studies, and is heterogeneous(Paykel ES 1971) Dexamethasone non-suppression occurs predominantly in the endogenous group, and to some extent, so do other neuroendocrine abnormalities, such as blunting of growth hormone response to clonidinc and prolactin response to tryptophan. Regarding treatment, the best ECT response is associated with the presence of psychomotor retardation and depressive delusions, characteristic of psychotic depression(Buchan H et al 1992). The endogenous picture may be useful as a characteristic of depressions that respond better to antidepressants than placebo, but this is not clear. However, boundaries are weak, with mixed cases common, and distributions on factors do not show consistent and convincing bimodality which would indicate separation of disorders. The relationship to severity, the loose and confusing definitions, and the overlap between psychotic depression and melancholia bedevil the area.

The term melancholia, used in DSM-III and its successors, is only non loaded once its original meaning of black bile is forgotten. It seems preferable to the term somatic depression used in ICD-10, because it is easier to use in English, where it easily forms the adjective melancholic. The concept of somatic depression can also refer to something quite different, associated with somatic disease, or with somatization. Whether this classification will survive forthcoming revisions of the official schemes in the next few years remains to be seen, but it still figures extensively in research and the literature. A spirited case has recently been made for its retention.

The place of life stress in this distinction has changed considerably. In older views of endogenous and non endogenous depression, life stress had a central role. However, the distinction is now made on the basis of symptom pattern rather than causal factors. Studies(Paykel ES 2003) have shown that there is little relationship between measures of preceding life events and the presence of melancholic symptoms. Most depressions are preceded by some life stress, often not sufficient to fully account for the episode so that other factors are also involved. In three of our own studies, in two of which the symptom data and the life event data were collected by different interviewers, we found little relationship between symptom type and previous life events.(Paykel ES 2003) Other studies of patients with and without the symptom pattern have found little difference between the groups regarding the occurrence of stressful life events prior to onset. However, there may be some differences once depressions have become severe and recurrent. In a sample of depressed females, when a melancholic/psychotic score based on the presence and severity of biological and psychotic symptoms was used, then severe life events were significantly less frequent in the melancholic/psychotic group.�Brown GW. Et al 1994). This significant difference emerged only when episodes other than the first were included. In another study,�Frank E. et al 1994) in which the sample comprised highly recurrent depressive, fewer life events were found in endogenous than nonendogenous Research Diagnostic Criteria sub-types, which depend on symptom features.

Other classifications includes;

• severity and minor depression
• dysthymia and subsyndromal depression
• single depressive episode versus recurrent depression

However it was sighted by Paykel ES 2003, that depression can be caused by the following;

1. Sadness and Grief
2. Serious Condition
3. Loss of Confidence
4. Ability to Function
5. Hopelessness
6. Low Mood
7. Loss
8. Aging and Loss of Independence
9. Bereavement and Loneliness
10. Relationships and
11. Biological Factors

Social Support

In general, social support refers to the various ways in which individuals aid others. Social support has been documented as playing an important and positive role in the health and well-being of individuals. To receive support from another, one must participate in at least one important relationship. However, social support has often been summarized as a network of individuals on whom one can rely for psychological or material support to cope effectively with stress. Social support is theorized to be offered in the form of instrumental support (i.e., material aid), appraisal/informational support (i.e., advice, guidance, feedback), or emotional support (i.e., reassurance of worth, empathy, affection).

Environmental resources include the individual’s social support system (Lazarus & Folkman, 1984). This system is attributed to all those individuals who have personal, social and familial relationships with others (Sarason, Sarason, & Pierce, 1990), and it refers to four major types of support: informative, instrumental, emotional and companionship support (Cohen & Wills, 1985). These types of support make it easier for the individual to cope with sources of stress (House,1981). Professional literature presents two major forms of influence of social support on Depression/well-being. One form is the main effect, where social support has a direct positive effect on an individual’s well-being regardless of stress. The basic claim is that the support has the power to develop and increase feelings of ability, self-esteem and self-efficacies. These feelings enable the individual to successfully cope with life’s depression. The second form is the buffer effect, where social support has an indirect effect on an individual’s well-being via the reduction of negative implications in the response to feelings of stress (Antonucci & Akiyama, 1994; Cohen & Wills, 1985). In this manner, the support constitutes a coping strategy (Antonucci & Akiyama, 1994). Social support can moderate stress by affecting first or second impressions of an event (Cohen & Edwards, 1989). When the individual gains access to a support network that is available to him, it may suppress impressions of potential threat stemming from the event, encourage the individual to believe in his/her ability to cope with the event and/or encourage the use of opportunistic coping strategies, such as: problem-solving and positive re-evaluation (Cohen & Edwards, 1989; Cohen & McKay, 1984). Various studies address the significance of social support for children, teenagers and youths in situations of stress in general and situations of war in particular. For children experiencing a crisis, the family constitutes the main support system. During a crisis, the family provides its members with feedback on feelings, ideas and behavior. This determines the child’s understanding of the nature and significance of a stressful environment (Zeidner et al., 1993). Approximately 80% of Jewish students and approximately 64% of Arab students in this study turn to parents or family members during crises; approximately 25% of Jews and 50% of Arabs turn to their teacher or someone on the school staff; approximately 16% of Jews and 38% of Arabs turn to school counselors, and approximately 75% of teenagers turn to friends when in distress (Harel et al., 2004). Aside from family support, friends’ and teachers’ support also have a curbing effect on the psychological difficulties stemming from war (Klingman, 2001; Klingman et al., 1993; Swenson & Klingman, 1993; Zeidner et al., 1993). Studies by Greenbaum, Erlich, & Toubiana (1993), examining the utilization of sources of support among children during the Gulf War revealed that utilization of support originating from parents and friends is relatively higher than support originating at school and from telephone hot lines. While family support has greater importance during childhood, friends and non-family members become a more significant source of support during teenage years (Cotterell, 1994). Most teenagers turn to friends their own age more than to their parents for shared entertainment, friendship and understanding (Blyth, Hill, & Theil, 1982), and for feedback, practical information and emotional support (Jaffe, 1998). A peer group serves as a source for powerful social rewards, including prestige, acceptance, status and popularity, which promote a teenager’s self-esteem (Bishop & Inderbitzen, 1995). Relation ships with one’s peers during teenage years are more characterized by intimacy and support than in early childhood (Jaffe, 1998); they play a crucial role in the promotion of normal psychological development (Steinberg, 2002) and constitute a protective element during times of stress (Montemayor & Van Komen, 1980). Chen & Wei’s study (2013) examines how social support of peers mediates the correlation between school victimization and well-being among 1650 junior high school students in Taiwan, and later on examines how gender and ethnicity differ in reciprocal relations of violence at school, social support and well being. Findings show that in general, students with a high level of well-being are not significantly linked with victimization by students in mediation of social support among peers.

Another study by Benhorin & McMahon (2008) examines the effect of social support on the correlation between exposure to violence and aggressive behavior. Findings demonstrate the negative effect of exposure to violence on aggressive behavior and the comprehensive contribution of social support in these relationships. Specifically, support from parents, teachers and close friends has been found to be positively linked to lower levels of aggressive behavior.

Effect of Social Support on Physical and Mental Health

Since Cassel's and Cobb's reviews, a great number of studies have been published under the rubric of social support. Most of these studies have focused on the effect of social support on physical or mental health directly or on its effect on the relationship between stress and health indirectly. Wallston and colleagues reviewed the human adult literature on social support and physical health focusing on illness onset, stress, utilization of health services, adherence to medical regimens, recovery, rehabilitation, and adaptation to illness. According to this review, the best evidence for the importance of social support was found in the literature on recovery, rehabilitation, and adaptation to illness. Across a variety of methods and physical disorders, there was consistent evidence that naturally occurring support was beneficial. Recent studies found that, among groups who were otherwise essentially equivalent in operative physical status, married patients who received higher spousal support took less pain medication and recovered more quickly than their low-support counter- parts (19). At this time, however, studies have failed to show a direct link between lack of support and illness onset. The best documented evidence for the effects was the role of social support on total mortality. In general, after controlling for traditional risk factors (such as blood pressure, cigarette smoking, and serum cholesterol levels), persons with higher social support scores were at lower risk for mortality than their more isolated counterparts (House JS, Robbiis C, et al 1982/1985). One classic study is the nine-year follow-up epidemiological study of Alameda County residents (Berkman LF, Syme SL 1979). People with few connections were found to be at increased risk of dying from many separate causes of death-ischemic heart disease, cancer, cardiovascular and circulatory disease, and all causes of death combined. Several prospective and retrospective studies in different communities have extended and, in part, replicated the findings of the Alameda County study (Litwak E, Messeri P et al 1989). These include the prospective study of adults in Tecumseh, Michigan, the 30-month prospective study conducted in Durham County, North Carolina, and the retrospective study of the national data on death (Litwak E, Messeri P et al 1989). Although these studies used different measures of social support and different criteria of mortality, their results were very consistent. Social support has also been found to have a significant positive effect on recovery from surgery, mortality rate, health care utilization, depression, and teenage pregnancy (Piisuk M, et al 1987).

Religiosity

Religiosity is an organized system of beliefs, practices, rituals, and symbols designed to facilitate closeness to the sacred or transcendent. Religiosity typically refers not only to a belief in a higher entity or something greater than oneself but also formal involvement in organized religious activities and specific, measurable acts such as prayer, meditation, service attendance, religious readings, and affiliation with a particular religion or place of worship ( Hill et al., 2000 ; Iecovich, 2001 ; Yohannes et al., 2008 ). A key characteristic of religion is that it is organized in a hierarchical fashion with an identified authority figure such as a priest, pastor, or rabbi presiding. Although religion refers to someone’s belief system, religiosity is the actual application of such beliefs in daily life.

Factors associated with religiousness influence on symptoms of depression, has received the most attention in the recent time literature. Many researchers have suggested that religiousness may reduce vulnerability to depressive symptoms by way of a variety of substantive psychosocial mechanisms. National surveys point to high rates of comorbidity between depressive symptoms and both drug abuse and drug dependence (Grant, 1995), which suggests that drug abuse and dependence may be risk factors for the development of depressive symptoms. Evidence also suggests that religious involvement is related to lower rates of substance use (e.g., tobacco, alcohol, and drugs) among both adolescents (D’Onofrio, Murrelle, et al., 1999) and adults (Kendler, Gardner, & Prescott, 1997). The effects of religion in deterring drug use may be largely through endorsing moral proscriptions and discouraging interaction with drug-using peers (D’Onofrio, Murrelle, et al., 1999). Therefore, by deterring drug use among adolescents and adults, religious involvement might indirectly influence people’s susceptibility to depressive symptoms. Social support. Religious involvement may afford people opportunities for social support, which has been found to protect against depressive symptoms (Koenig et al., 2001; George, Larson, Koenig, & McCullough, 2000). People who are involved in religion have substantially more informal social contacts and are more active in civic engagements than people who are not (Putnam, 2000). Insofar as religious involvement puts people in touch with such sources of social support, this participation may be a mechanism that accounts for some of the inverse association of religiousness and depressive symptoms. Appraisal of life events. Religiously involved people may have resources for appraising negative life events that reduce the perceived stressfulness of those events (Pargament, 1997). To the extent that religious people believe that their lives are controlled by a higher power or that negative life events happen for a reason or that life events are opportunities for spiritual growth, they may experience life events as less threatening and less stressful (George et al., 2000). As a result, these positive appraisals may help to protect some religious individuals from depressive symptoms by helping them to perceive negative events as less stressful. Coping with stress. Pargament (1997) also described how a variety of religious cognitions and behaviors that help religiously involved people to cope with stress may deter negative mental health outcomes. Relatedly, Koenig et al. (1992) reported that medically ill men who reported using religion to cope with their physical health problems also reported less severe depressive symptoms, even with a variety of other demographic, physical, and psychosocial predictors of depression controlled. Such findings suggest that religiousness may protect people against depressive symptoms by helping them to avert the negative psychological sequelae that are frequently associated with stressful life events.

Self-Esteem

Self-esteem refers most generally to an individual’s overall positive evaluation of the self (Gecas 1982; Rosenberg 1990; Rosenberg et al. 1995). It is composed of two distinct dimensions, competence and worth (Gecas 1982; Gecas & Schwalbe 1983). The competence dimension (efficacy-based self-esteem) refers to the degree to which people see themselves as capable and efficacious. The worth dimension (worth-based self-esteem) refers to the degree to which individuals feel they are persons of value.

We all have an innate sense of who we are: our self. Not only do we possess a highly elaborated cognitive self-concept, but we also hold a highly accessible affective sense of how skilled, lovable, and worthy we are as a person. This global evaluation of one’s worth is known as self-esteem. Self-esteem is typically viewed as a continuous dimension ranging from high to low: people with high self-esteem feel very positive about them- selves, whereas those with low self-esteem feel ambivalent or uncertain about themselves. Truly negative self-evaluations or self-hatred are unusual and typically found only in clinical populations (Brown et al., 2001;Leary and MacDonald, 2003). This global evaluation is the most common definition of self- esteem, and is considered relatively stable (i.e., an individual can be said to have a dispositional level of self-esteem). It is also sometimes referred to as self-worth, self-regard, or self- evaluation –all of which have the same essential meaning. The construct of self-esteem has a long and checkered history within the discipline of psychology. William James (1890), one of the first psychologists, first proposed that people develop high self-regard when they consistently meet their personally important goals or standards in life. He also recognized that such ‘meeting’is subjective, and not objectively accurate. Contemporary views of self-esteem similarly concern one’s perceived, rather than objectively assessed, worth. Throughout the twentieth century, self-esteem was heralded as a psychologically important construct. The psychologist Abraham Maslow (1943) included self-esteem as a fundamental need in his influential hierarchy, arguing that it is not possible to achieve fulfillment without first meeting the need for self-worth and self-respect. Similarly, leading humanistic theorist Carl Rogers (1959) focused on self-worth (i.e., self-esteem) as reflecting the congruence between one’s current self and ideal self. According to Rogers, self-worth re- flects the extent to which parents (and others) provide us with unconditional positive regard (i.e., love and respect). If others convey unrealistic ideals, or lead us to believe we are not meeting those ideals, self-worth suffers. Like Maslow, Rogers saw high self-worth as important for helping a person to face challenges, cope effectively with problems, and form healthy relationships. However, self-esteem really became popularized in the 1960s. Rosenberg’s (1965) large-scale survey of adolescents raised the concept’s profile among researchers by developing the first questionnaire measure of self-esteem and linking it empirically to anxiety and depression. At the same time, Coopersmith (1967) and Branden (1969) made well- publicized links between self-esteem and confidence, academic achievement, and mental health. Self-esteem became viewed as a panacea –the key to success in life. The following decades saw the development and dominance of the so-called ‘self-esteem movement’ in Western society, which focused on the idea that raising people’s (especially children’s) self-esteem will make them happy, successful, and law-abiding. This principle was used abundantly to design educational curricula, rehabilitation programs, and self-help books that would increase the self-esteem of students, people convicted of crimes, and those suffering from addictions or other psychological difficulties (Nolan, 1998). Little empirical research was conducted to evaluate the validity of these assumptions or the success of these programs until the 1990s. When such research was conducted, its results were mixed at best, calling into question the usefulness of self-esteem interventions.

In recent decades, thousands of empirical studies on self- esteem and its development, correlates, and consequences have been conducted. The findings from this vast literature provide a more nuanced understanding of the complexities of self-esteem and the role it plays in our lives. Self-esteem can no longer be viewed as a unitary concept: there are multiple aspects of self-esteem that can be considered relevant (see Sec- tion Other Aspects of Self-Esteem). Moreover, self-esteem can no longer be viewed as a panacea: it is highly relevant to some aspects of intrapersonal and interpersonal functioning, but less relevant (or less causally influential) to others. Greater awareness of these complexities will help scholars and practitioners to better understand and take self-esteem into account in clinical practice.

2.2 THEORETICAL REVIEW

Self determination theory (SDT)

Self Determination theory according to Ryan (1995) is an “organismic psychology” one of a family of holistic psychological theories including Piaget and Rogers. It assumes that people are active organisms with inherent and deeply evolved tendencies toward psychological growth and development. Self Determination Theory (SDT) argues that there are three basic psychological needs, namely: need for autonomy, relatedness, and competence. When these needs are supported and satisfied within a social context, people experience more vitality self motivation, and well-being. Conversely the thwarting or frustration of these basic needs leads to diminished self motivation and grater ill-being (Ryan & Deci, 2006). According to Ryan and Deci (2006), SDT has five mini theories. They include: Cognitive Evaluation Theory (CET) Organismic Integration Theory (OIT); Causality Orientation Theory (COT); Basic Psychological Needs Theory (BPNT); and Goal Content Theory (GCT).

Cognitive Evaluation Theory (CET):

Deci, Koestner and Ryan (1999) used the concept of “Intrinsic Motivation” to explain well-being. CET is framed in terms of social and environmental factors that facilitate versus undermine intrinsic motivation. The variables considered in this theory are competence and autonomy. CET was presented by Deci and Ryan (1985) as a sub theory within SDT that had the aim of specifying factors that explain variability in intrinsic motivation. CET focuses on two fundamental needs: perceived competence and autonomy which are enhanced or diminished based on environmental and social factors. Perceived competence accompanied by feelings of autonomy has been shown to have a positive impact in intrinsic motivation. CET has three prepositions, firstly, environmental and social-context lead to feelings of competence which in turn have a positive affect in intrinsic motivation; secondly, intrinsic motivation is positively impacted when people feel competent and autonomous or self-determined; lastly, when people engage in activities for internal rather than external reasons, there will be a positive affect on intrinsic motivation. When these factors influence intrinsic motivation, it either enhances or undermines intrinsic motivation and this in turn increases or reduces the well-being of an individual.

Organization Integration Theory (OIT)

OIT addresses the process of internalization of various extrinsic motives. Here, the focus is on the continuum of internalization, extending from external regulation, to introjections (i.e engaging in behaviours to avoid guilt or feel approval), to identification, to integration. These forms of regulation which can be simultaneously operative, differ in their relative autonomy with external regulation being the least autonomous form of extrinsic motivation and integrated regulation the most autonomous.

SDT research show that the more autonomous the person’s motivation, the greater their persistence, performance, and well-being at an activity or within a domain. OIT further suggests that internalization and integration is facilitated by contextual supports for autonomy competence, and relatedness. That is, individuals are more likely to internalize and integrate with respect to it, efficacy in engaging in it and connection with those who convey it.

Considerable researches across the globe show that greater internalization of cultural practices is associated with greater wellness (Ryan & Deci, 2000).

Causality Orientation Theory (COT)

According to Ryan and Deci (2006), causality orientation theory describes individual differences in how people orient to different aspects of environment in regulating behaviour. When in individual is autonomy oriented, he/she orients to what interests them and acts with congruence. A focus on this autonomy oriented events therefore enhance the individual’s well-being. Also, when control oriented, a person primarily regulates behaviour by orienting to social controls and reward contingencies, and when personally oriented, a person focuses on their lack of personal control or competence. The theory is arguing that the extent to which individuals channel their behaviours to these sources of controls in their lives determines the person’s well-being.

Basic Psychological Needs Theory (BPNT)

Ryan and Deci (2000) elaborated on the concept of basic needs by connecting them directly with wellness. BPNT posits that each need exerts independent effects on wellness, and moreover that the impact of any behaviour or event on well-being is largely a function of its relations with need satisfaction. Research on BPNT shows that aggregate need satisfaction predicts individual differences in health and wellness, as well as within person fluctuations in wellness across time.

Goal content theory (GCT)

This theory states that materialism and other extrinsic goals such as fame or image do not foster well-being even when one is successful at attaining them (Kasser and Ryan, 1996). In contrast, goals such as intimate relationships, personal growth, or contributing to one’s community are conducive to need satisfaction and therefore facilitate health and wellness. GCT has also been applied to how goals framed towards intrinsic aims are better adhered to than those focused on extrinsic outcomes (Vansteenkiste, Lewis, and Deci, 2006). Other theories of well-being apart from SDT include;

Set-point theory:

The set-point theory of subjective well-being has dominated the field for over 30 years (Headey, 2006) and has become the paradigm theory (Kuhn, 1962), of subjective well-being research its central proposition is that adult individuals have differing but stable levels of subjective well-being levels substantially due to personality traits and other factors which are partly hereditary or determined early in life. It also assumes that adult subjective well-being is not supposed to change. Major life events can cause deviations from the set-point but their effects are usually transitory and after a period of “deviation”, people return to their previous set-points.

This implies that changes in life circumstances do not have long term effects on our happiness. People adapt to major life events, both positive and negative and our happiness pretty much stays constant through our lives even if it is occasionally perturbed. This theory predicts that winning the lottery for example will not make one happier in the long run. While a divorce or even a major illness will throw life into an upheaval, over the long run, your happiness level will eventually return to where it was before.

Set point theory has appeared to be so convincing because it developed in a cumulative fashion with layer on layer of evidence supporting it and making it seem more convincing in its account of links among three set of variables: stable person characteristics including personality traits, life events, and measures of well-being (life satisfaction, positive affect) and ill-being (anxiety depression, and stress). Note worthy is the fact that at least five other labels have been used to describe what has developed into and is now generally known as set-point theory. Adaptation Level (AL) theory, personality theory dynamic equilibrium theory; multiple discrepancies theory and; homeostatic theory (Headey, 2009).

Brickman and Campbell (1971) initiated developments by proposing an adaptation level theory of well-being. They observed that most individuals returned to ‘balance’ (later termed ‘equilibrium level’ or ‘set point’) even after what would previously have been thought of as life changing events. This proposition has been corroborated by Brickman, Coates and Tanoffbullman (1978) and Easterlin (1974).

The next major development came when Costa and McCrae (1980) proposed a personality theory of subjective well-being. They showed that individuals have differing SWB baselines or set points partly due to differences in scores on the stable personality traits of extroversion (E) and Neuroticism (N). Extroverts rated higher on SWB than introverts and relatively neurotic people rated lower than emotionally stable individuals.

Heady and Wearing (1989-1992) sought to extend subjective well-being theory by linking personality life events and SWB in what they termed Dynamic, equilibrium theory. Using data from an Australian panel study, they observed that history repeats itself in people’s lives that the same life events tend to keep happening to the same people. Events which happen to a person are seen as being partly driven by his/her stable characteristic. It was shown that extroverts tend to experience many positive events and that neurotic individuals experience many negative events, (Heady and Wearing, 1992, Magnus, Diener, Fuijita, and Pavot, 1993). Further, extroverts tend to magnify the impact of positive events extracting greater satisfaction from them than offers (Lucas, & Baird, 2004). Similarly, neurotic people magnify the impact of adverse events (Larsen, 1992). The personality trait of openness to experience (O) is also implicated. People who rate high on “O” report many positive and many negative events, while people who rate low on “O” report few events of either kind (Heady and Wearing, 1989).

A key implication of Heady and Wearing results is that provided only a person’s normal or predictable pattern of life’s events happen in any given period, then subjective well-being will not change. A person’s subjective well-being only changes when events occurs which are abnormal for him or her. Another implication is that if one knows three things about a person-his/her level of extroversion, Neuroticism, and openness to experience, then one can fairly well predict the sort of events which keep on happening to him/her. This pattern of result lead heady and wearing to refer to equilibrium levels of well-being and ill-being (rather than “base line” or “set point”) and to conceive of personality, life events, well-being and ill-being in dynamic equilibrium.

Some researchers have down played the significance of individuals differences in subjective well-being and focused on the fact that very large majority report levels of SWB well above scale mid-points i.e more “satisfied” and “dissatisfied”(heady 2009). Multiple discrepancies theory (Michalos, 1985) and homeostatic theory (Cummins, 1995) are concerned with explaining this outcome and describing the mechanisms which keep it in place.

Hedonistic theory (Hubin, 2004)

This theory was first postulated by Aristotle who identifies well-being with pleasure. This theory argues that well-being consists in a subjective balance of pleasure over unpleasant experiences and nothing more. This view accommodates the plausible thought that if anything matters for welfare, it is the pleasantness of our life experiences. Therefore, for one to have positive well-being one needs to experience a higher qualify of pleasurable experiences over unpleasant ones. The theory is divided into two: Quantitative hedonism and Qualitative hedonism. In quantitative hedonism, all pleasures are qualitatively the same considered, only in themselves (apart from their effect, to whom they occur, and so forth) they differ only in intensity and duration. As an analogy, one can think of there being a bell in the head that can be rung by many different bell ropes, but there is only one bell. Different ringing of the bell differ in themselves only in how loud they are and how long they go on. On the other hand, qualitative hedonism states that there are qualitative differences in pleasure. Some are qualitatively better, not just more intense or longer lasting than others. On this view, one may have a better life-one with a higher level of well-being even if one has less pleasures, provided one has “higher quality” pleasure.

Eudaimonic theory

In contrast to the hedonistic theory this theory clearly distinguish well-being as something separate from happiness by arguing that not all desires and pleasures will contribute to well-being and may even cause harm. Aristotle argued that well-being should rather extend beyond pleasure to capture one concept of human flourishing that incorporates the idea of realizing one’s true potential (diamon) (pyff, 1995, Ryff and keyes, 1995; keyes, 2002). This theory defines well-being in terms of the degree to which a person is full functioning and engaging in modes of thought and behaviour that provide engagement and fulfillment. It incorporates the idea that well-being is about achieving a sense of purpose and meaning in life (i.e self realization) other them pursuing pleasure.

Authentic Happiness Theory

Sumner (1996) identifies well-being with being authentically happy. Being happy where one’s happiness is both informed about the condition of one’s life and autonomy meaning that it reflects values that are truly one’s oppressive social condition. Happiness is something like subjective-well-being involving both global attitudes of life satisfaction and positive affect, though summer calls his view a life ‘satisfaction’ account, the root idea is that one’s happiness should reflect response to a life that is one’s own whereas desire theories face the problem of how irrelevant desires or fulfillment that do not impact on experience, can affect one’s well-being the authentic happiness view incorporates an experience requirement only what affects the individual’s happiness can alter his/her well-being.

Relative theory

This is one of the economic theories that explained the conceptof well-being. Easterlin (1974) opined that the impact of income on subjective well-being depends on standards that change over time according to the individual’s expectations and social comparisons. This factors such as the relationship between the present and former economic situation in relation to that of reference individuals (meadow, 1992) could influence a person’s happiness regardless of his/her income level (Diener and Diener, 1996, padducci, 1968). This implies that an individual’s level of income does not really influence his/her well-being directly but what matters is who she/he compares himself/herself with, as well as his/her expectation of what he/she is supposed to earn at a particular point in time.

2.3 EMPIRICAL REVIEW

A 2001 review of over 630 separate data-based studies of religion and well-being, meaning and purpose, mental health, and psychosocial factors revealed that 120 studies examined the relationship between level of religious involvement and depression, eight of which were clinical trials (Koenig, McCullough, & Larson, 2001). In this 2001 review, 60 of 93 (65%) of the studies revealed a significant positive relationship between at least one aspect of religious involvement and lower rates of depression; 4 reported greater depression among the more religious; 13 studies reported no association; and 16 studies gave mixed findings. Relatively few studies have explored the relationship between religion and depression using a longitudinal design, and generally these have had follow ups of not more than one year (Koenig, McCullough, & Larson, 2001; Nasser & Overholser, 2005; Horowitz & Garber, 2003; Wink, Dillon, & Larson, 2005; Murphy & Fitchett, 2009; Dew, Goldston, McCall, Kuchibhatla, Schleifer, Triplett, & Koenig, 2010; Payman & Ryburn, 2010; Perez, Little, & Henrich, 2009; Cruz, Schulz, Pincus, Houck, Bensasi, & Reynolds, 2009; Krause, 2009). Out of approximately 19 prospective cohort investigations reviewed in 2001, the majority revealed that greater religious involvement at baseline predicated lower rates of depression on follow-up (Koenig, McCullough, & Larson, 2001). When measuring ‘organizational religious involvement,’ which refers to participation in public, social, or organizational religious practices, six prospective studies found a positive association with lower prevalence of depression (Maton, 1989; Idler & Kasl, 1992; Kennedy, Kelman, Thomas, & Chen, 1996; Koenig, George, & Peterson, 1998; Musick, Koenig, Hays, & Cohen, 1998; Musick & Strulowitz, 2000). Musick and Strulowitz (2000) conducted a seven-year prospective study of 8,866 randomly sampled American youths. Formal religious attendance was measured by attendance at religious services and involvement in synagogue- or church-related social events, while informal religious involvement was measured by frequency of participation in different religious groups. Findings revealed that, while cross-sectional assessment did not indicate significant results, formal religious involvement significantly predicated less depressive symptoms and depressed affect at the seven-year follow-up for Christians. Conversely, among Jews, formal religious involvement predicted greater depressive symptoms and affect at follow-up. Informal religious involvement predicted fewer depressive symptoms for Jews and greater depressive symptoms in Christians (Musick and Strulowitz, 2000). In their review, Koenig, McCullough, and Larson (2001) categorized the aspect of religiosity that refers to private religious activity (for example, private prayer) as “nonorganizational religious activity.” Longitudinal studies that assessed this dimension of religiosity pointed to inconsistent results. In a study of medically ill, depressed older adults (N = 87), Koenig, George, and Peterson (1998) found that private religious activity was not associated with remission rates. However, a study of 1,902 female twins indicated that personal devotion (including frequency of prayer) was predictive of lower rates of depressive symptoms 5 months later (Kendler, Gardner, & Prescott, 1997). Longitudinal studies that assessed single-item measures of self-rated religiousness and importance of religion, which Koenig, McCullough, and Larson (2001) call “religious salience,” indicated that this subjective measure of religiosity tends to be predictive of lower rates of depression (Rabins, Fitting, Eastham, & Zabora, 1990; Ross, 1990; Braam, Beekman, Deeg, Smit, & Tilburg, 1997; Shafer, 1997). One of these investigations was an international longitudinal study with a one-year follow-up in the Netherlands, which found that elderly people who indicated that “a strong religious faith” was one of the three most important factors in their life had only 38% the odds of recurrence of depression in comparison with those who did not ascribe such importance to their religious faith. This association was most prominent among older adults with poor physical health (Braam, Beekman, Deeg, Smit, & Tilburg, 1997). In a prospective study of 83 psychology undergraduates, Park, Cohen, and Herb (1990) administered six-item intrinsic religiousness and extrinsic religiousness scales at two time points across a two-month period. Findings revealed that greater intrinsic religiousness was associated with lower prevalence of depression over time. In the aforementioned study of elderly depressed adults, Koenig, George, and Peterson (1998) found comparable results showing that scores on a 10-item intrinsic religious motivation scale predicted the speed of remission of depression. A representational longitudinal study (three-year follow-up) of 2,836 adults from the general population revealed that while religious attendance was not associated with symptoms of depression, once demographic and physical health variables were controlled, there was a significant correlation between religious salience (self-rated religiousness and importance of religion) and symptoms of depression; individuals who did not identify as religious and individuals who saw themselves as extremely religious had more frequent symptoms of depression when compared to those who considered themselves moderately religious (Schnittker, 2001). Schnittker utilized the single-item measure of subjective importance of religious or spiritual beliefs to evaluate religious salience and, specifically, to look at the potential for curvilinear main effects between this aspect of religiosity and depression. While previous research has found evidence for an inverted U-shape effect, suggesting clarity and/or confidence in one’s beliefs is an important factor in attenuating depression, Schnittker’s findings found the opposite: those with either low or high levels or religious salience reported more depression than those with moderate levels of religious salience. Of the eight clinical trials reviewed in the 2001 review, five showed that patients with depression who received religiously oriented interventions recovered more quickly than those who received non-religiously oriented psychotherapies (Koenig, McCullough, & Larson). A comprehensive meta-analysis that reviewed 147 studies (N = 98,975) found that religiousness reduces vulnerability to depressive symptoms and discussed possible mediators of this association, including substantive psychosocial mechanisms, such as lower substance use, social support, appraisal of life events (cognitive appraisal), and ability to cope with stress (Smith, McCullough, & Poll, 2003). Murphy, Ciarrochi, Piedmont, Cheston, Peyrot, and Fitchett (2000) found that in a study of clinically depressed adults, depressive symptoms were negatively correlated with religious belief after controlling for demographic variables. Echoing findings from earlier mentioned reviews, another review of the literature on religiosity and depression indicates that religious importance predicts lower incidence of depressive symptoms and that religiosity may increase the speed of recovery from depressive disorder (Dein, 2006). The protective impact of religiosity has been shown in various populations. In a study of adolescent psychopathology and religiosity, which utilized a denominationally, ethnically, and socioeconomically diverse sample of 615 adolescents, findings revealed that forgiveness, daily spiritual experiences, and religious coping were associated with lower rates of depressive symptomatology in females (Desrosiers & Miller, 2007). In the above study, results also indicated that most dimensions of religiosity and spirituality were associated with greater life satisfaction in adolescents (Kelley & Miller, 2007). As part of Weissman’s (1987) study, Miller (1997) showed that intrinsic religiosity (a personal sense of the importance of spirituality and religion) and not extrinsic religiosity (including frequent attendance of religious services)was found to be protective against depression recurrence in mothers with major depressive disorder (MDD). Miller’s study, which looked specifically at maternal religiosity and male and female offspring, found that mothers (G1) for whom religion was highly important were 81% less likely to have MDD compared to mothers for whom religion was not highly important. Catholicism versus Protestantism was also found to be protective: Mothers who were Catholic were 79% less likely to have MDD. No association was found between the prevalence of maternal MDD at time 10 and frequency of attendance to religious services. Miller et al. (1997) found no significant association between offspring depression status and any of the three measures of offspring religiosity. The study found a marginally significant trend in the data which supports the hypothesis that maternal religiosity is protective against offspring MDD; Compared with daughters whose mothers did not consider religion highly important, daughters whose mothers considered religion highly important were 60% less likely to have MDD (p=.09). This trend was only evident for daughters. Compared with a son whose mother was Protestant, a son whose mother was Catholic was 78% less likely to have MDD (p=.09); this association was not significant among daughters. There was no association between maternal frequency of attendance of religious services and offspring depression. The above findings point to the importance of recognizing spiritual and religious domains in developing insightful and effective healthcare. What it means to identify as religious or spiritual varies widely across individuals and is both nuanced and multifaceted. In considering the impact of religiosity on the development and trajectory of depression, the criteria for MDD involving feelings of worthlessness and feelings of emptiness are salient (American Psychiatric Association, 2000). Leading theories about the association between religiosity and depression include the potential mediators of social support, religious coping, and the role of cognitive appraisal (Dein, 2006). Westgate (1996) posits that “a holistic model, interventions for depression would address the physical, affective, cognitive, social, and spiritual dimensions” (p. 26). Throughout his years of clinical work, Jung came to believe that neither intellectual nor moral understanding was adequate but that psychological well being was found in discovering a spiritual framework for living one’s life (1933). In his book, The Unheard Cry for Meaning, psychiatrist and neurologist Victor Frankl emphasized the innate need to find meaning in life and discussed the discontent of the modern era as a problem of meaninglessness (1978). In attempting to unpack the relationship between religiosity and depression, the present study will focus on the potential mediator of cognitive appraisal and meaning making.

2.4 CHAPTER SUMMARY

In this review the researcher has sampled the opinions and views of several authors and scholars on the availability and utilization of school library resources. The works of scholars who conducted empirical studies have been reviewed also. The chapter has made clear the relevant literatures.