Mediators of the association between religious service attendance and mortality.

Mounting evidence consistently shows associations between religious service attendance and reduced mortality risk, yet research identifying mediators remains limited. Using prospective data from the Health and Retirement Study (2006-2014; n = 5,200 US adults), we evaluated a range of potential mediators. After robust control for confounders (demographic, health, health-behavior, and social factors), among positive psychological factors, we observed mediation through increased life satisfaction (5.27%; P ≤ 0.001) and possibly positive affect (1.52%; P = 0.06) but not optimism, mastery, or purpose. Among dimensions of psychological distress, we observed mediation through reductions in hopelessness (1.92%; P = 0.01), trait anger (1.98%; P = 0.03), state anger (2.23%; P = 0.03), and possibly loneliness (1.21%; P = 0.06), but not cynical hostility or negative affect, and some evidence that increased anxiety (-3.61%; P = 0.008) and possibly depressive symptoms (-1.14%; P = 0.05) increased mortality odds. Among social factors, we observed mediation through contact with friends (10.73%; P = 0.005) but not living with a spouse or contact with children or other family. Among health behaviors, we observed mediation through exercise (5.38%; P ≤ 0.001) and negative mediation through alcohol frequency (-2.55%; P = 0.03) and possibly body mass index (-2.34%; P = 0.08) but not smoking. These results highlight a range of mediators that might underlie the association between religious service attendance and reduced risk of mortality.