Attachment,Religiosity,and Perceived Stress Among Religious Minorities During the COVID-19 Pandemic: The Impact of Cultural Context

Abstract

The COVID-19 pandemic has had a profound effect on stress levels around the world. In developing nations such as Pakistan, lack of resources and socioeconomic inequalities have compounded the negative impact of the pandemic, especially for minorities. Religion in the developing, collectivistic, Muslim-majority nation of Pakistan is a powerful identity marker inherited at birth and reflected in all identifying documents. A well-developed conceptual framework for religion is attachment to God, which has demonstrated strong predictive value for perceived stress in Western samples. Given the importance of other attachment relationships as well, this study has examined the predictive value of attachment to parents, attachment to God, and religiosity on perceived stress in Christian minorities within a Pakistani context. The sample consisted of 183 adult Christian Pakistanis. Multiple regression indicated that religiosity, attachment to father, and attachment to God were the strongest predictors of perceived stress, though not in the same pattern as expected in Western contexts. This finding demonstrates the importance of the impact of culture, attachment relationships, and religious context on perceived stress, indicating a need to consider both religion and culture in psychological care, as well as local and international public policy, to mitigate stress along minorities in developing nations in such uncertain times.

Keywords

COVID-19 minorities perceived stress culture religiosity attachment developing nations Pakistan

Introduction

The COVID-19 pandemic, as well as the associated restrictive measures to slow the spread of the virus, has had a negative impact on levels of perceived stress around the world, with the average person reporting at least moderate levels of perceived stress (Limcaoco et al., 2020). This impact is even greater among minorities, with recent survey by the American Psychological Association (APA, 2020) reporting moderate to high levels of COVID-19-related stress among people of color in America. In addition, the pandemic’s negative effects on developing nations are expected to be the most substantial and long-lasting in terms of health, social, and economic impact (Bruckner & Mollerus, 2020). As developing nations already have fewer health and social service resources available, and with limited testing capacity, Bruckner and Mollerus (2020) have further hypothesized that the COVID-19 pandemic will have the most profound and lasting impact on the economies, health systems, and social structures of these disadvantaged nations.

Moreover, researchers have discovered a differential negative impact of the pandemic on minority groups across several countries (Centers for Disease Control and Prevention [CDC], 2020; Intensive Care National Audit and Research Centre [ICNARC], 2020; Tai et al., 2021), which is posited to be a result of health disparities, as well as long-standing inequalities that impact those of minority status (Public Health England [PHE], 2020; Tai et al., 2021). For example, the adjusted mortality rate of South Asians in Britain is the highest of any ethnic minority (Harrison et al., 2020) and the age-adjusted rate of death for Black and Indigenous Americans is more than three times the rate of Whites (AMP Research Lab, 2020). This situation is compounded by greater vulnerability to stress and to the effects of stress that has been found within Christian minorities in Pakistan (Ahmad & Mushtaq, 2014). Given this delineation of risk factors, it becomes essential to assess the level of perceived stress and its correlates within vulnerable minority populations of these developing nations.

The Pakistani Context

The Islamic Republic of Pakistan is considered a strongly patriarchal and collectivistic, Muslim-majority nation with fewer than 4% of its population reporting other religions, of which less than 2% are Christian (Pakistan Bureau of Statistics, 2020). This collection of cultural factors makes Christians in this country a religious minority who are particularly vulnerable to stress and probable candidates for the differential negative impact of the COVID-19 pandemic on minorities.

In Pakistan, hierarchical distance is created between men and others. For example, women are often considered the possessions of their father, brother, or husband. This means that a woman’s status in society is dependent upon these relationships (Chauhan, 2014; Islam, 2004; Ziring & Burki, 2021). Moreover, in collectivistic cultures such as Pakistan, group needs generally take precedence over individual goals (Ziring & Burki, 2021) and, though in Western countries, religion is often considered a personal choice; importantly, religion in Pakistan is literally an identity marker that is obtained at birth. It is included on all identifying documents such as birth certificates, passports, and national identity cards. Importantly, some researchers argue that interpretations of parts of the constitution of Pakistan only grant full citizenship—and the rights associated—to those who are Muslims (Fuchs & Fuchs, 2019).

Religion in Pakistan is therefore often considered an inherited aspect of identity with strong familial and societal pressure to remain within the religion of birth. In addition to these important characteristics of religion within this cultural context, research in Western nations has shown that religiosity and perceived stress are negatively correlated (Leman et al., 2018). The protective factor of religion and religiosity in the Western context therefore may or may not translate to this cultural context.

Attachment as a Theoretical Framework for Religion

In addition to the constructs of religious affiliation and religiosity, researchers have used Bowlby (1969/1982; Bowlby, 1973) and Ainsworth’s (1985) theory of attachment as a rich conceptual framework for understanding religion in terms of relationship rather than practices or values (Granqvist, 2020). This framework has been used to describe religion in terms of attachment to God as a substitutionary, physically absent object that creates a sense of safety and security amid stressful events and uncertain times. Secure attachment to God is particularly helpful in mitigating stress and distress as the “secure base” is available when other attachment figures are absent, such as in the face of loss of a loved one (Granqvist, 2020). Granqvist (2020) further explained that the availability of this substitutionary attachment figure gives comfort, connection, and a sense of security, thereby mitigating the perception of stress. The secure attachment figure is attentive and present, allowing for a greater sense of safety and a feeling of proximity, thereby attenuating feelings of stress. Using attachment theory to understand religion therefore has many practical implications for prediction of perceived stress (Bradshaw et al., 2010; Granqvist, 2014; Granqvist & Kirkpatrick, 2013). Moreover, this characterization of religion as attachment also conforms to the evangelical perspective of religion as a personal relationship with God and, very importantly, integrates aspects of collectivistic culture as it conceives of religion in relational terms (Granqvist, 2014) Furthermore, research has shown that attachment to God is often a more robust predictor of distress than religiosity (Leman et al., 2018; Stulp et al., 2019).

The Importance of Attachment Relationships

Religion and religiosity are undeniably important aspects of Christian Pakistani culture. However, the importance of other attachments in this highly relational collectivistic culture cannot be disregarded. In a review of the research, Rabbani et al. (2014) indicated that there is a clear negative relationship between secure parental attachment and perceived stress in individualistic cultures. The authors noted, however, that little is known about this relationship in collectivistic cultures. While some researchers consider attachment to be a universal construct, others have argued that cultural context is an important determinant of styles of attachment, particularly the emphasis on relational harmony within collectivistic cultures (Chen, 2015). Specifically, these cultural differences are thought to lead to differential distribution of attachment types and a stronger connection between attachment and various indicators of well-being (Chen, 2015). Importantly, Granqvist (2014) posited that attachment to God can be heightened by a multitude of other factors, including other secure attachment relationships and low social welfare. Moreover, he stated that attachment to God is significantly impacted by the interaction of internal working models and the cultural context, especially from those in positions of authority (Granqvist, 2020). This is of particular importance in a culture where the strict hierarchical structure gives great honor to those in authority and the prominent collectivistic cultural tendency emphasizes the importance of family and loyalty (Ziring & Burki, 2021).

In Pakistan specifically, similar to Western countries, parental attachment has been found to be correlate of mental health, particularly depression and anxiety (Khalid et al., 2018; Zia & Shahzad, 2019). Importantly, when considered together, attachment to parents, attachment to God, and religiosity have significant predictive value, above and beyond most demographic variables, for perceived stress in both individualistic and collectivistic cultures (Khodarahimi et al., 2016; Reiner et al., 2010). Therefore, this study aims to elucidate the levels of perceived stress among adult Christian minorities in Pakistan during the COVID-19 pandemic and to ascertain the predictive value of demographic variables, religiosity, attachment to parents, and attachment to God, on their perception of stress.

Hypotheses

The first hypothesis is exploratory in nature and aims to elucidate the level of perceived stress among this understudied population. Specifically, it is hypothesized that Christians in Pakistan, being minorities, will have moderate to high levels of perceived stress. Rates of perceived stress during the COVID-19 pandemic have been shown to be moderate in the general population (Limcaoco et al., 2020) and moderate to high among people of color in America (APA, 2020).

The aim of the second hypothesis is also exploratory: to elucidate the predictors of perceived stress within the cultural context of Pakistan. In particular, though previous research posits a direction between each of these attachment relationships and perceived stress, given that this is the first study of its kind in a collectivistic culture, it is hypothesized that attachment to parents, attachment to God, and religiosity will predict perceived stress.

Method

Procedure

This study was approved by the Institutional Review Board (IRB) of Forman Christian College (A Chartered University; IRB Approval #: IRB-219/02-2020), and all requirements were met including informed consent. No ethical breaches occurred during the study. Inclusion criteria were identifying as Christian and being above the age of 16 years (i.e., adults; the age of consent in Pakistan is 16 years old). Participants were recruited through social media (e.g., WhatsApp, email, SMS) via snowball sampling, given both the small population of Christians in the country and the restrictive nature of the COVID-19 pandemic.

Participants clicked on a Google Forms link provided to them by the researchers and were presented with an informed consent page. The first question following this page was about age and religion. Those who chose “Christian” and were above the age of 16 years were allowed to proceed. The choice of any other religion sent them to the “Thank you” page and did not allow them to participate in the study, given that the questionnaires were deemed inappropriate for the Muslim population due to the sensitive nature of religion in Pakistan. Participants were then requested to forward the questionnaire to their Christian friends and family. Data were gathered from April to July 2020, during a period of time when there was a significant increase in cases of COVID-19, as well as a 2-week period of strict lockdown and several regional “smart” lockdowns. The participants were not compensated.

Participants

Power analysis indicated that 108 participants were required to compute a standard multiple regression with an alpha level of .05 at 80% power. The participants were 183 adult Christian Pakistanis across the country who ranged in age from 17 to 51 years (M = 24.07, SD = 6.04), with 44.2% men and 55.8% women. Education levels ranged from completion of some school to completion of post-doctoral fellowship, with most participants in the midst of their BS/BA education (68.4%). Unexpectedly, most participants were from nuclear family systems (i.e., only parents and children living together; 71.3%) rather than joint family systems (i.e., multiple generations living together; 28.2%) and half considered religion a personal choice rather than inherited. Demographic variables are presented in Table 1.

Table 1.

Demographic Variables of the Study Participants.

Variables	Percentage	Range	M (SD)
Gender
Male	44.2
Female	55.8
Age		17–51	24.07 (6.04)
Level of education (years)		11–21
Completed some school	0.6
Freshman	19.3
Sophomore	11.0
Junior	13.8
Senior/Super senior	24.3
Completed BA/BS	7.7
Working on masters	10.5
Completed MS/MA/MPhil	6.1
Working on doctorate	3.9
Completed doctoral degree	1.7
Post-doctoral fellow	0.6
Family system
Nuclear	71.3
Joint	28.2
Perception of religious choice
Choice	49.7
Inherited	49.7

Note. M = mean, SD = standard deviation

Measurement tools

Demographic variables

A demographic questionnaire was included in the measurement tools. This questionnaire included items about religion (i.e., Christianity, Islam, Other), age, gender, education level, type of family system nuclear (having only parents and children living together) or joint (having multiple generations living together), and perception of religion as a personal choice or something that is inherited from the family you are born into.

Attachment to parents

The Experiences in Close Relationships—Relationship Structures Questionnaire (ECR-RS; Fraley et al., 2011) is a 7-point Likert-type (1 = strongly disagree to 7 = strongly agree) self-report questionnaire that was used in this study to measure attachment to mother and father along two dimensions: anxiety (items 1–6) and avoidance (items 7–9). There are many versions of this questionnaire to measure different attachment relationships. An example of the instructions for measuring maternal attachment is “Please answer the following questions about your mother or a mother-like figure.” and includes items such as “It helps to turn to this person in times of need.” Higher scores are interpreted as greater anxiety and avoidance. When measuring parental attachments, the scale has shown good test–retest reliability (α > .90; Fraley et al., 2011) and predictive validity. In this study, the reliability for all subscales was good (ECR anxiety mother α = .837; ECR anxiety father α = .849; ECR avoidance mother α = .827; ECR avoidance father α = .816). Due to a technical error, one item on the mother anxiety subscale was missing for 61 participants; however, analysis of the remaining two items on the scale indicated a similar shape of the distribution of this variable, as well as similar means, standard deviations, and reliability (α = .847). Therefore, this two-item version of the maternal anxiety subscale was utilized.

Attachment to God

To measure the variable of attachment to God, the Attachment to God Inventory (AGI) developed by Beck and McDonald (2004) was employed. Similar to the ECR-RS, the inventory includes the two dimensions of anxiety and avoidance. AGI has a total of 28, 7-point Likert-type items, with 14 measuring avoidant attachment (α = .84; Beck & McDonald, 2004) and 14 measuring anxious attachment (α = .80; Beck & McDonald, 2004). The Likert-type scale ranges from 1 = disagree strongly to 7 = agree strongly. The scale includes items such as “My experiences with God are very intimate and emotional” and “Even if I fail, I never question that God is pleased with me” (Beck & McDonald, 2004), with a higher score indicating greater avoidance and anxiety, respectively. This study also demonstrated good reliability for each subscale (avoidant attachment α = .854; anxious attachment α = .817).

Religiosity

The Centrality of Religiosity Scale (CRS; Huber & Huber, 2012) is a 10-item scale used in this study to measure the religiosity of the participants. The scale uses 5-point Likert-type questions ranging from 1 = never to 5 = very often along five dimensions that have been theoretically defined as core to religiosity: intellect (e.g., “How interested are you in learning more about religious topics?”), ideology (e.g., “To what extent do you believe in the afterlife?”), public practice (e.g., “How important is personal prayer to you?”), private practice (e.g., “How important is it to you to take part in religious services?”), and religious experience (e.g., “How often do you experience situations in which you have the feeling the God or something divine is present?”; Huber & Huber, 2012, p. 717). Higher scores indicate greater religiosity. The CRS-10 has been normed across multiple countries and religions with strong correlations between the CRS-10 and self-report measures of salience of religiosity (r = .73), a commonly used measure of validity for religiosity (Huber & Huber, 2012). Reliability estimates range from .89 to .94 (Huber & Huber, 2012), and the scale demonstrated similar reliability estimates in this study (α = .863).

Perceived stress

The 10-item version of the commonly used Perceived Stress Scale (PSS) developed by Cohen et al. (1983) was used to measure the level of perceived stress over the past month using a 5-point Likert-type scale. This scale includes items such as “In the last month, how often have you found that you could not cope with all the things that you had to do?” (Cohen et al., 1983). The PSS has demonstrated adequate validity and reliability (Cohen et al., 1983), and in this study, the reliability was good (α = .840). Higher scores on this scale indicate greater amounts of perceived stress (i.e., 0–13 = low perceived stress; 14–26 = moderate perceived stress; >27 = high perceived stress).

Data analysis

To answer the first hypothesis regarding levels of perceived stress, descriptive statistics were computed. To answer the second hypothesis, a standard multiple regression was computed.

Results

Descriptive statistics of the study variables

Descriptive statistics were computed for all study variables and are displayed in Table 2. The participants reported an average level of anxious attachment that was lowest for mother (M = 1.73; SD = 1.45), slightly higher for father (M = 2.28; SD = 1.67), and again slightly higher for God (M = 3.71; SD = 1.11). Participants reported a lower average avoidant attachment style toward God (M = 2.50; SD = 1.10), compared to mother (M = 3.47; SD = 1.40) and father (M = 4.13; SD = 1.53). These values indicate that on average, this sample reported secure attachment with mother, dismissing-avoidant attachment with father, and preoccupied attachment with God (Fraley, 2020). High average levels of religiosity were reported (M = 22.29; SD = 7.21; Huber & Huber, 2012), and the average level of perceived stress in this sample was 23.47 (SD = 6.29), indicating moderate levels of perceived stress on average (Cohen et al., 1983). The range of perceived stress scores was 6–36 with the majority of participants (62%) reporting scores of 14–26, again indicating moderate levels of perceived stress. Almost one third (32%) reported experiencing high levels of stress (scores of 27 or greater). Only 10 participants (6%) had scores at the cutoff of 13 or below, indicating low levels of stress. These findings support the first hypothesis regarding the levels of stress among minorities and suggest moderate to high levels of stress in this population.

Table 2.

Descriptive Statistics of the Study Variables.

Variables	Frequency (%)	M	SD	α
ECR M Av		3.47	1.40	.827
ECR M An		1.73	1.45	.847
ECR F Av		4.13	1.53	.816
ECR F An		2.28	2.28	.849
AGI Av		2.50	1.10	.854
AGI An		3.71	1.11	.817
CRS		22.29	7.21	.863
PSS		23.47	6.29	.840
Mild stress	6 (3.47)
Moderate stress	62 (35.84)
Extreme stress	32 (18.50)

ECR M Av: Experiences in Close Relationships Scale (mother avoidance subscale); ECR M An: Experiences in Close Relationships Scale (mother anxiety subscale); ECR F Av: Experiences in Close Relationships Scale (father avoidance subscale); ECR F An: Experiences in Close Relationships Scale (father anxiety subscale); AGI Av: Attachment to God Inventory (avoidance subscale); AGI An: Attachment to God Inventory (anxiety subscale); CRS: Centrality of Religiosity Scale; PSS: Perceived Stress Scale, 0–13 = mild stress, 14–26 = moderate stress, >27 = extreme stress.

Multiple regression

A standard multiple regression was computed to test the degree of prediction of each of the demographic and study variables on perceived stress. Prior to completing inferential analysis, testing for violations of assumptions underlying multiple regression was conducted. Three subscales were not normally distributed and were therefore transformed to improve normality (Pallant, 2013; Tabachnick & Fidell, 2006). For ECR mother anxiety subscale, the inverse (1/X) transformation was utilized (skewness = 2.456; kurtosis = 5.827). Square root (Sqrt) transformation was used for ECR father anxiety subscale (skewness = 1.191), and for CRS (skewness = 1.216; kurtosis = 1.348), the logarithm (Log10) transformation was computed. Level of education was converted into the number of years of education (i.e., completed BA/BA = 16 years, completed doctoral degree = 21 years). Only one outlier was identified for Mahalanobis distances using the p > .001 criterion (Mahalanobis distance = 32.92, cutoff at p < .001 = 31.295) and therefore was retained. Missing values did not show any pattern and, given the small number of Christians in Pakistan and the substantial difficulty of obtaining the sample, missing values were imputed rather than excluded. Table 3 displays the bivariate correlations among the study variables.

Table 3.

Correlations Among Study Variables.

Variables	2	3	4	5	6	7	8	9	10	11	12	13
1. Gender	.052	.064	−.065	.156	−.147	.072	−.128	−.024	−.449**	.057	−.223*	.133
2. Age		.629**	.179	−.103	.052	.024	−.115	−.078	−.090	−.270**	−.120	−.169
3. Education			.031	−.012	.005	−.021	−.189	−.112	−.105	−.123	−.009	−.162
4. Family system				.040	.036	−.006	−.033	−.131	.034	−.081	−.105	.031
5. Religion					.112	−.067	.090	.128	.050	.143	.146	.139
6. ECR M Av						−.297**	.439**	.160	.219*	.039	.147	.104
7. ECR M An Inv							−.157	−.322**	−.112	−.166	−.115	−.062
8. ECR F Av								.533**	.232	.173	.235*	.277**
9. ECR F An Sqrt									.042	.255**	.156	.168
10. AGI Av										.177	.570**	−.003
11. AGI An											.255**	.374**
12. CRS (Log10)												.169
13. PSS

Education: year of education; religion: choice or inherited; ECR M Av: Experiences in Close Relationships Scale (mother avoidance subscale); ECR M An Inv: Experiences in Close Relationships Scale (mother anxiety subscale; inverse); ECR F Av: Experiences in Close Relationships Scale (father avoidance subscale); ECR F An Sqrt: Experiences in Close Relationships Scale (father anxiety subscale; square root); AGI Av: Attachment to God Inventory (avoidance subscale); AGI An: Attachment to God Inventory (anxiety subscale); CRS: Centrality of Religiosity Scale (Log10); PSS: Perceived Stress Scale.

p < .05. **p < .01.

To test the degree of prediction of each variable on perceived stress, the demographic variables (gender, age, years of education, family system, perception of religion as choice vs. inherited) and study variables (CRS, ECR subscales, AGI subscales) were entered into the regression model as independent variables with PSS as the dependent variable. See Table 4 for the regression model including unstandardized regression coefficients, standardized regression coefficients, semipartial correlations, R, R², and adjusted R².

Table 4.

Results of the Multiple Linear Regression.

Variables	Unstandardized coefficients	Standardized coefficients		t	R	R ²	Adjusted R²	Semipartial correlations
Variables	B	β	p value	t	R	R ²	Adjusted R²	Semipartial correlations
1. (Constant)	8.297		.175	1.361	.498	.248	.195
Gender	1.404	.114	.146	1.459				.098
Age	−0.009	−.099	.922	−0.097				−.007
Education	−0.300	−.105	.240	−1.179				−.079
Family system	1.228	.090	.201	1.283				.086
Religion	0.478	.039	.584	0.549				.037
CRS (Log10)	8.216	.169	.050	1.970				.132
ECR M Av	0.099	.022	.781	0.279				.019
ECR M An (Inv)	0.137	.007	.929	0.090				.006
ECR F Av	0.994	.243	.008	2.666				.178
ECR F An	−0.813	−.065	.454	−0.751				−.050
AGI Av	−1.032	−.179	.053	−1.951				−.130
AGI An	1.817	.318	.000	4.242				.284

Gender: gender was dummy coded as male = 0 and female = 1; education: year of education; religion: choice or inherited; CRS: Centrality of Religiosity Scale (Log10); ECR M Av: Experiences in Close Relationships Scale (mother avoidance subscale); ECR M An Inv: Experiences in Close Relationships Scale (mother anxiety subscale; inverse); ECR F Av: Experiences in Close Relationships Scale (father avoidance subscale); ECR F An: Experiences in Close Relationships Scale (father anxiety subscale); AGI Av: Attachment to God Inventory (avoidance subscale); AGI An: Attachment to God Inventory (anxiety subscale); PSS: Perceived Stress Scale.

The overall regression model was significant [R = .498, R² = .248, F(12, 180) = 4.625, p < .001] supporting the second hypothesis. The adjusted R² (.195) value indicates that almost 20% of the variance in perceived stress is predicted by the combination of demographic variables, religiosity, attachment to parents, and attachment to God; however, the only significant predictors of perceived stress were religiosity (β = .169), avoidant attachment to father (β = .243), and both subscales of attachment to God (anxiety β = .318, avoidant β = −.179). Taken together, higher levels of religiosity, higher levels of avoidance in attachment to father, and more anxious, but less avoidant attachment toward God, predicts greater stress. Calculation of effect size indicated a large effect (Cohen’s f² = .329).

Discussion

The two primary goals of this study were to ascertain the level of perceived stress within Christian minorities in Pakistan during the COVID-19 pandemic and to elucidate the predictors of perceived stress within this population. As expected, given the differential impact of COVID-19 on minorities (CDC, 2020; ICNARC, 2020; Tai et al., 2021), the levels of perceived stress within this sample were similar to the moderate to high rates of stress among people of color in America (APA, 2020). Most participants reported at least moderate levels of perceived stress, and almost one third experienced high levels of perceived stress. This finding highlights the negative impact of COVID-19 on an already vulnerable population. This finding was expected from the statistics around the world, which suggest that the greatest impact of the COVID-19 pandemic is within minority groups in developing nations (APA, 2020; Bruckner & Mollerus, 2020; CDC, 2020; ICNARC, 2020; Tai et al., 2021).

The second hypothesis was also supported. When examining the predictors of perceived stress within this group, anxious attachment to God was the strongest predictor, accounting for 10.1% of the variance in perceived stress, while avoidant attachment to God (3%), attachment to father (5.9%), and religiosity (2.9%) also accounted for a proportion of the variance in perceived stress. Interestingly, attachment to mother was not a significant predictor in this equation. Possible explanations for this finding might be provided by the patriarchal nature of the Pakistani cultural context (Chauhan, 2014; Islam, 2004; Ziring & Burki, 2021). Granqvist (2020) has noted that those in positions of authority can often have a significant impact on a child’s cognitive model and fathers in Pakistan are certainly in a strong position of authority. Moreover, given the importance the relationship to father holds in multiple spheres of life, it is possible that the pragmatic and survival necessity of this relationship eclipses the secure maternal bond that the average Pakistani in this study reportedly shares with his or her mother. It is possible that this is particularly true when it comes to perceived stress in the face of uncertainty and times of great upheaval.

An interesting finding of this study is that religiosity was a weak positive predictor of perceived stress. This finding diverges from previous research on levels of religiosity and stress in Western contexts, in which higher levels of religiosity, though not in as significant a fashion as attachment to God, act as a buffer against stress and other negative outcomes (Leman et al., 2018; Stulp et al., 2019). Taking into consideration the cultural and religious context, it is very likely that the minority status of this group and the narrative of the dangers of being a Christian in Pakistan have some impact on this relationship (Anonymous, 2018; Fuchs & Fuchs, 2019). Discrimination in the form of attacks on Christian places of worship, blasphemy laws, and everyday microaggressions (Anonymous, 2018; Fuchs & Fuchs, 2019) might create greater levels of stress in people who are more highly religious as they would not hide their religious affiliation and may fear disapproval or discrimination from the majority group. Therefore, perhaps higher levels of religiosity, as measured by activities such as church attendance and discussing religious issues, serve as reminders of the dangers inherent in being a Christian in this country. Greater visibility and more reminders of their religious status not only increase the actual physical risk but may also prime Christians in this context to focus on those risks, thus increasing levels of perceived stress via both evolutionary and cognitive pathways. In particular, research has indicated that daily chronic stress, in this case religious discrimination, can have a detrimental effect on well-being (Bolger et al., 1989) and that cognitive appraisals play a strong role in either mitigating or augmenting levels of stress (Lazarus & Folkman, 1984).

Another possibility is that more religiosity may encompass only the traditional rituals and not a change at a deeper level. Those who are highly religious may not necessarily be living lives that are in line with their family’s beliefs. Given the significant pressure many Christians experience from the larger majority culture, this may create a sense of cognitive dissonance that increases anxiety and stress (Festinger & Carlsmith, 1959).

It is also tenable that the finding of a negative relationship between avoidant attachment to God and perceived stress follows these same pathways. As avoidant attachment increases, perceived stress decreases. The concept of God as less personal may in some ways mitigate stress as there is less risk and fewer reminders of disadvantaged status in a distant, less personal relationship with God. Moreover, resolution of cognitive dissonance (Festinger & Carlsmith, 1959) in a more avoidant attachment style may assist in the reduction of stress. Specifically, the family of origin expects, encourages, and approves of Christian affiliation, identity, traditions, and behaviors in their loved ones. On the contrary, the individual may perceive disapproval and discouragement of Christian traditions, affiliation, and identity from the majority culture. The individuals of the minority group may experience cognitive dissonance between these contradictory views from family and the majority group. In turn, this dissonance leads to stress. Therefore, the individuals engage in a more avoidant attachment to God to deal with the stress.

It is also possible that the collectivistic tendency of this culture has some impact on this dimension of the attachment relationship and its connection to perceived stress. As noted, collectivistic cultures tend to focus on the group needs, prioritizing them over individual desires (Ziring & Burki, 2021). Higher levels of avoidance in attachment relationships might be an adaptive mechanism that maintains the patriarchal hierarchy, as well as respect for those in authority, and thereby supports the harmony of the larger group (Ziring & Burki, 2021). Importantly, research also suggests that those with more avoidant attachment styles are better able to suppress unwanted thoughts and fear of abandonment to deal with difficult relational situations (Fraley & Shaver, 1997). It may be that this collectivistic culture fosters a more avoidant attachment style in service of the greater good which increases the harmony of the group, thereby helping group members to suppress both unwanted thoughts and feelings of abandonment. This in turn would reduce levels of perceived stress.

It is important to note that anxious attachment to God was the strongest predictor of perceived stress, stronger than avoidant attachment to God, anxious attachment to father, and level of religiosity. This indicates that even in the face of adversity and disadvantage, the sense that God is a “safe” place and a refuge in times of need is a buffer against stress. Being able to address God personally, knowing that he loves, cares, and accepts in an unconditional fashion, and that He is present and near, these are the most important factors predicting the level of perceived stress among this group.

Implications, Limitations, and Future Directions

Given the rates of perceived stress in this sample of Christians in Pakistan during the COVID-19 pandemic, the importance of monitoring and providing care for this vulnerable population cannot be understated. This sample was more highly educated on average than expected of the Christian population in Pakistan. As level of education is another factor known to mitigate stress (Feizi et al., 2012), it is possible that rates of stress in this time are even greater among lower income, less educated Christians in Pakistan. Strategies for mitigating these levels of stress should be implemented immediately to attenuate the long-term impact of moderate to high levels of stress on an already high-risk population (Ahmad & Mushtaq, 2014). At the governmental level, public health policies should be reconsidered to take into account the health disparities and inequalities that compound the stress of the current situation for minorities (PHE, 2020; Tai et al., 2021). Importantly, lawmakers and governmental officials should consider ways of creating a more inclusive environment for all minority groups within Pakistan. At the international level, support for the health and economic sectors of these vulnerable communities is paramount to their success in recovering from the economic and social impact of COVID-19 to meet sustainable development goals (Bruckner & Mollerus, 2020).

In addition, this research highlights the significance of attachment relationships in times of great stress. Importantly, those in leadership positions within the Pakistani Christian community should be educated on the importance that paternal attachment figures and attachment to God hold in mitigating stress. Strikingly, it is not strictly a secure attachment that per say mitigates perceived stress; the results of this study did not replicate the Western ideal of “secure” attachment with God reducing stress. It is possible that in the cultural context which emphasizes group cohesion and maintenance of relational harmony (Chen, 2015; Ziring & Burki, 2021), attachment styles that are more “secure” in the Western sense do not adhere to the cultural ideals. For example, a child who exhibits a secure attachment is able to play independently, not a social ideal in Pakistan. It is possible that exactly the type of secure attachment that is so valued in Western contexts creates greater independence and therefore interpersonal conflict and “stress” within the family system. The collectivistic cultural context should therefore be considered in any interventions.

Specifically, in the education of pastors and lay-leaders, emphasis should be placed on the importance of a low-anxiety personal relationship with God and ways of fostering attachment to God that are culturally relevant should be taken into consideration. Strategies that promote the theological realities of a God who loves unconditionally, accepts and is pleased with His children, and never leaves or forsakes those He has chosen would be ideal. Based on this study, it would be ideal if the focus on the God of justice and righteous anger, though important theological ideas, would become secondary to the full picture of a gracious God who loves and pursues despite the wrong-doing and sins of His people.

In addition, the patriarchal values of Pakistani culture should not be underestimated in their probable impact on attachment relationships. Given the importance of strict stratification of society within collectivistic culture, there is perhaps an adaptive mechanism at work here that has yet to be elucidated. Attempts to reduce levels of avoidance in attachment or focus on Western ideals of fostering “secure” attachment may be shortsighted. Further research could focus on studying the possible positive impact of the phenomenon of avoidant attachment toward leaders and those in authority in Pakistan further.

Moreover, psychologists can play an important role in encouraging clients to function in a more adaptive fashion as the therapist can act as a stand in attachment figure. In this way, the therapeutic relationship can provide a “corrective emotional experience” by monitoring and calibrating therapeutic interventions and the therapeutic relationship to provide the security and safety that might have been missing in early attachments (Mallinckrodt, 2010). In this way, therapy can be tailored to provide that corrective attachment relationship which can be transferred to other attachment objects, such as significant others or God, thereby mitigating perceived levels of stress. Importantly, these interventions should be contextualized for use in collectivistic cultures.

In a systematic review and meta-analysis, Wright and Edginton (2016) have noted that most attachment interventions are focused on children in Western countries in more individualistic cultures. In addition, given the mixed results of most of the studies available, they have stressed the importance of high-quality research in early intervention. In the current cultural context, it seems that a less anxious and more avoidant attachment style in relationship to God is more protective than the “typical” secure attachment style that is so valued in Western contexts. Given this finding, it is clear that further research is paramount in understanding attachment relationships in various cultural and religious contexts so that appropriate interventions can be developed.

Conclusion

Christian minorities in Pakistan report high levels of perceived stress during the COVID-19 pandemic. These levels of stress are mitigated most strongly by a less anxious attachment to God, followed by attachment to father, and religiosity. The findings were not entirely in line with previous research, which underscores the importance of cultural and religious context in the provision of psychological care and social policies at the local and international level.

Footnotes

Acknowledgements

The authors would like to express their gratitude to all those who participated in the study.

Authors’ Note

The authors declare that this research article is their original work and that all three authors have agreed to and take full responsibility for the content of this article. The authors also declare that this research article has not been published previously and has not and will not be sent for consideration by another journal while submitted to the Journal of Psychology and Theology. Furthermore, the authors declare that all ethical policies have been considered and followed regarding human participants in research. The data set used in this study is available upon request.

Author Contributions

All three authors were involved in the conceptualization of the project. The first and second authors gathered the data, computed the data analysis, and wrote the “Results” section. The first author wrote the initial draft of the remaining sections of the article. The final draft was reviewed and edited for content, theory, and cultural sensitivity by the third author.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Permission to Use Measurement Tools

All measurement tools used in the study were openly available for public use. For the Experiences in Close Relationships—Relationship Structures Questionnaire (ECR-RS), permission to use the scales can be viewed at this webpage http://labs.psychology.illinois.edu/~rcfraley/measures/relstructures.htm. For the Attachment to God Inventory (AGI), the scale and scoring instructions can be found in Beck and McDonald’s (2004) article “Attachment to God: the Attachment to God Inventory, tests of working model correspondence, and an exploration of faith group differences.” Items and scoring for the Centrality of Religiosity Scale (CRS) are available in the article by Huber and Huber (2012) entitled “The Centrality of Religiosity Scale.” The Perceived Stress Scale (PSS) scale and coding is available in the article by entitled “A Global Measure of Perceived Stress.”

ORCID iD

Elizabeth Schwaiger

Author Biographies

Dr. Elizabeth Schwaiger has been an assistant professor in the department of psychology at Forman Christian College (FCC; A Chartered University) since Spring 2016. In Fall 2018, she established one of the first cognitive psychology research laboratories in Pakistan at FCC. She is a licensed psychologist in Massachusetts and completed her post-doctoral training at McLean Hospital in Belmont before moving to Pakistan to teach psychology where she lives with her husband Dr. Ivan Suneel and their son Jayden.

Syeda Saniya Zehra received her bachelor’s degree in Psychology from Forman Christian College (FCC; A Chartered University) in 2020. She is currently enrolled for MS Clinical Psychology Program at FCCU. Her areas of interest in research are attachment, COVID and its impact on mental health, and substance use with the Pakistani population. She aspires to practice as a Clinical Psychologist after the completion of her degree.

Dr. Ivan Suneel is an associate professor and Chairperson of the Department of Psychology at Forman Christian College (FCC; A Chartered University). He completed his Ph.D in Clinical Psychology in 2016. His research interests lie in the indigenous research, family dynamics and drug abuse. Dr. Suneel is a practicing Christian and is involved in Church related activities too. He is married to Dr. Elizabeth Schwaiger, and lives in Lahore, Pakistan with their son Jayden and dog Ginger.

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