eISSN: 2084-9885
ISSN: 1896-6764
Neuropsychiatria i Neuropsychologia/Neuropsychiatry and Neuropsychology
Bieżący numer Archiwum Artykuły zaakceptowane O czasopiśmie Rada naukowa Bazy indeksacyjne Prenumerata Kontakt Zasady publikacji prac
Panel Redakcyjny
Zgłaszanie i recenzowanie prac online
SCImago Journal & Country Rank
Poleć ten artykuł:
Udostępnij:
Artykuł oryginalny

Investigating the association between spiritual well-being and psychological symptoms in multiple sclerosis patients: A cross-sectional analytical study

Ali Dehghani
1

  1. Department of Community Health Nursing, School of Nursing, Jahrom University of Medical Sciences, Jahrom, Iran
Neuropsychiatria i Neuropsychologia 2024; 19, 1:
Data publikacji online: 2024/03/08
Plik artykułu:
- investigating.pdf  [0.10 MB]
Pobierz cytowanie
 
Metryki PlumX:
 

Introduction

Multiple sclerosis (MS) is a chronic illness that destroys the myelin of the central nervous system and affects sensory and motor function (Dehghani et al., 2019). This disease is one of the most common neurological diseases in people (Dobson and Giovannoni 2019). About 2.5 million people in the world are suffering from MS and every week 200 people are added to them. As a result, 80% of sufferers have some degree of disability and the condition of only 1 out of 5 people remains stable and does not progress towards disability (Mahdizadeh et al. 2019). According to the latest statistics of the Iranian MS Society, the number of MS patients is 78,890 (Iran MS Society 2018). Based on the study by Azami et al. (2019), the prevalence of MS in men and women was estimated at 16.5 and 14.8 per 100,000 people in Iran, respectively. Therefore, the increasing trend of MS patients in Iran calls for the need to pay attention to the treatment and problems of the patients.
Psychological symptoms including stress, anxiety and depression are common problems in these patients, which can affect different aspects of life, including quality of life, daily functioning, and social and family life in these patients (Ramezani et al. 2021). Therefore, it is essential that health care professionals pay more attention to psychological symptoms in these patients and regularly evaluate these symptoms in patients. Often in chronic diseases, the psychological aspects of the disease are ignored, while most patients adapt to these psychological aspects (Ghodspour et al. 2018). On the other hand, most patients with MS also believe that stressful events and depression and anxiety symptoms can aggravate the disease (Ghodspour et al. 2018; Hanna and Strober 2020). The results of a study on MS patients showed that symptoms of relapse and frequent hospitalizations were more common in patients with higher stress levels. The results of this research showed that 85% of cases of exacerbation of multiple sclerosis were related to stressful events (Homayuni et al., 2021a). Also, the results of studies indicate that the negative effects of stress, anxiety and depression in these patients have caused many patients to abandon their work (Homayuni et al., 2021a; Hanna and Strober 2020). Therefore, since these psychological symptoms in MS patients have a high prevalence and can affect all aspects of the patients’ quality of life, it is necessary to pay more attention to reducing these symptoms.
There are several concepts about how to adapt and face with the psychological symptoms caused by the disease. One of these concepts is spiritual health, which, as one of the dimensions of health, causes the integration of other dimensions of health in people (Juškiene. 2016). According to the definition of the World Health Organization, health has different physical, mental, social and spiritual dimensions, and since spiritual health is a superior power of human interaction with the universe (Akbari and Hossaini 2018) it is essential to consider spiritual health and spirituality as one of the dimensions of health in patients, especially patients with chronic diseases (Tirgari et al. 2022). Spirituality, as an awareness of existence or power beyond the material dimension of life, creates a deep sense of unity or connection with the universe (Skrzypińska 2021b). Spirituality as a health promotion activity can play an important role in how patients deal with the consequences of MS (Homayuni et al. 2021b). Studies have shown that spirituality can have a positive effect on quality of life, health and life satisfaction in patients (Homayuni et al. 2021b; Desborough et al. 2020). However, less information is available about young patients with chronic diseases such as MS (Homayuni et al. 2021b). Many studies also indicate the relationship between spirituality and physical and mental health and improving adaptation to illness (Bravin et al. 2019; Lucchetti et al. 2021). Among the results of McNulty et al.’s study (2004) on patients with MS, spiritual beliefs were found to be beneficial in adapting to the disease. The results of the Balboni et al. study (2022) also showed that those who found the meaning of life in the disease based on spirituality had a better quality of life. Therefore, since technical interventions related to life-threatening factors have not been able to respond to the problems faced by incurable patients, paying attention to strong parameters such as spiritual health in different societies is expanding (Scherer et al. 2021). Also, in addition to medicinal actions, the effect of non-medicinal actions such as exercise, energy conservation strategy, and the use of spiritual and religious interventions on reducing disease symptoms also needs investigation and research.
The present study was conducted with the aim of determining the association between spiritual health and stress, anxiety and depression in MS patients.

Material and methods

The current research was a cross-sectional analytical study that was done with the aim of determining the association between spiritual health and stress, anxiety and depression in MS patients of the Jahrom MS Society in southern Iran from January to June 2023. In this research, the convenience sampling method was used to select research samples. In this way, the researcher was present at the place of the MS Society on consecutive days and at different hours of the day, and the patients completed the research questionnaires. The sample size in the current research was determined to be 193 people with a confidence coefficient of 95% and a test power of 80%.
The inclusion criteria included diagnosis of multiple sclerosis by the physician, age range 18-50 years (due to the prevalence of MS disease during this period), experience of at least one year of the disease, literacy and willingness to participate in the study. Exclusion criteria included suffering from other acute or chronic physical, mental or psychological disorders and incomplete completion of study questionnaires.
Data gathering tools
1. Demographic characteristics of patients including age, sex, marital status, education, duration of disease, frequency of disease recurrence in the last year, number of hospitalizations in a year and type of MS.
2. Spiritual Well-Being scale: In this research, in order to measure spiritual health, the Palutzin and Ellison (1982) Spiritual Well-Being scale was used. This questionnaire has 20 options. The total score of spiritual health is between 20 and 120. The answers to these questions are classified as a 6-item Likert scale from completely disagree to completely agree. The spiritual health of people is divided into three categories: low (20-40), moderate (41-99) and high (100-120) (Paloutzian and Ellison 1982). The validity and reliability of this questionnaire were implemented and confirmed in Iran by Farahaninia et al. in 2004 on 283 nursing students. The reliability rate using Cronbach’s α coefficient for this questionnaire has been reported as r = 0.82 (Farahaninia et al. 2006).
3. Depression, Anxiety and Stress Scale – 21 items (DASS-21): In this research, the DASS-21 scale was used to evaluation of patients’ stress, anxiety and depression. The scale of this questionnaire is not at all (score zero), low (1), moderate (2) and high (3). In this tool, there are 7 items related to checking stress, 7 items related to checking anxiety and 7 items related to checking depression. The rating of this tool is such that numbers between 0 and 4 are considered as normal stress, anxiety and depression, 5 to 11 as moderate stress, anxiety and depression, and more than 12 as severe stress, anxiety and depression (Lovibond and Lovibond 1995). The DASS-21 questionnaire has been used in Iranian studies, including the studies by Aghebati (2005) and Ghafari et al. (2008). The validity and reliability have been confirmed. The reliability of this tool has also been confirmed in various studies, including the study of Ghafari et al. for anxiety with r = 0.71, stress with r = 0.74, depression with r = 0.97 and the reliability of the whole tool with r = 0.91 (Ghafari et al. 2008).
Statistical analysis
The process of data analysis was done using SPSS 21 and using descriptive and analytical statistics. For the purposes of descriptive statistics, statistical indicators such as mean, standard deviation, frequency and percentage were used. Spearman’s test was used to determine the correlation between spiritual health and stress, anxiety and depression. The significance level was considered as p ≤ 0.05.
Ethical approval
This research was confirmed by the ethics committee of Jahrom University of Medical Sciences (Ethics Number: IR.JUMS.REC.1400.051). All nurses signed an informed consent form. The objectives and method of the research were explained to them and they were then given sufficient assurance regarding the confidentiality of the information. Also, this study was carried out according to the ethical principles of the Declaration of Helsinki.

Results

Based on the findings, the age of the patients participating in the research was 33.31 ±9.79 years. Also, the average experience of the disease was 6.38 ±4.85 years. Other data are presented in Table 1.
According to the findings presented in Table 2, the majority of patients had moderate spiritual health (50%), 48.5% of patients had high spiritual health, and 1.5% of patients had low spiritual health.
According to the findings presented in Table 3, the stress, anxiety and depression levels of the majority of patients were moderate.
According to Spearman’s correlation test, there was a significant negative correlation between spiritual health and stress (p = 0.03, r = –0.39), anxiety (p = 0.001, r = –0.42) and depression (p = 0.01, r = –0.51) in MS patients. This means that with the increase in spiritual health in patients, the levels of stress, anxiety and depression decreased (Table 4).

Discussion

The emergence of mental problems in people with chronic illness and their complicated and long treatments have been considered as important concerns for the personnel of the care team (Howard and Khalifeh 2020). The present study was conducted with the aim of determining the relationship between spiritual health and psychological symptoms among patients with MS. Based on the findings, a strong relationship between spiritual health and psychological symptoms of patients was observed, such that patients with higher spiritual health suffer less from stress, anxiety and depression. Over the past periods, spiritual health has become an increasingly important consideration in the mental health profession (Milner et al. 2020).
The findings of this study are similar to the previous findings and those obtained in previous research, in people reporting a higher rate of participation in spiritual programs as well as reporting reduced problems of depression (Brown et al. 2013).
Brown et al. (2013) found that people reporting higher rates of religiosity and spiritual health might also experience a decrease in psychological and emotional disease. Also, the findings of the Zare et al. (2019) study showed that there was a positive and significant correlation between spiritual wellbeing and mental health in cancer patients receiving chemotherapy.
Results of studies also revealed that spiritual health is a significant agent of positive physical and mental health consequences (Perkins et al. 2021; Yamada et al. 2020) and could serve as a significant support approach when adapting to a life-threatening illness with decreasing psychological disorders like depression. As a result, patients with higher spirituality exhibit better coping skills and adapt to chronic disease, increased psychological well-being and quality of life than individuals without these beliefs (Scherer et al. 2021). A systematic meta analysis of 147 studies of depression and spiritual health in the community at large showed a low but statistically significant correlation, such that individuals who were more spirituality experienced had lower depressive signs (Smith et al. 2003). The results of these studies revealed that individuals who experience stressful negative life events, such as chronic diseases, may use spirituality to find meaning and purpose with the benefit of mitigating psychological signs (Smith et al. 2003; Wilson et al. 2017).
The results of the study by Bożek et al. (2020) show that both spirituality and health-related behaviors are positively related to psychological well-being. The results of the Martínez and Custódio (2014) study showed a significant correlation between mental health and spiritual wellbeing. The findings of this study showed that spiritual health was the strongest predictor of mental health, psychological distress, and psychosomatic complaints. Similar to the results of our study, the results of Senmar et al. (2020) indicated a negative and significant relationship between the total score of spirituality and the levels of stress, anxiety, and depression.
Overall, the results of the research suggest that people with higher rates of spiritual health may also experience an improved sense of well-being and a decline in psychological, emotional, and physical disease. Individuals are more likely to use spiritual health as an approach for better coping with their illness. This matter could be taken into consideration by the health teams of these patients to consider essential methods to increase spiritual health and provide spiritual care.
This study had several limitations. First, the samples may not be representative of all patients with MS in Iran, as patients were recruited from one center in the south of Iran. Also, a convenience sampling approach was one of the limitations of this research.

Conclusions

The findings showed that by increasing the level of spiritual health in patients, the levels of stress, anxiety and depression in MS patients decrease. Therefore, by using appropriate interventions and planning in this regard, by increasing the state of spiritual health and spirituality in these patients, the psychological symptoms of the patients can be reduced in order to improve the quality of life.

Funding statement

This study has been financially supported by the Research Department at Jahrom University of Medical Sciences.

Acknowledgments

We sincerely thank all patients who participated in this research.

Disclosure

The authors declare no conflict of interest.
References
1. Akbari M, Hossaini SM. The relationship of spiritual health with quality of life, mental health, and burnout:
2. The mediating role of emotional regulation. Iran J Psychiatry 2018; 13: 22-31.
3. Aghebati N. Effects of touch therapy on pain and psychiatric symptoms (Depression, anxiety and stress) of cancers patients. (Dissertation). Faculty of Medical Sciences, Tarbiat Modares University, Tehran 2005; 65-70.
4. Azami M, YektaKooshali MH, Shohani M, et al. Epidemiology of multiple sclerosis in Iran: A systematic review and meta-analysis. PloS One 2019; 14: e0214738.
5. Balboni TA, VanderWeele TJ, Doan-Soares SD, et al. Spirituality in serious illness and health. JAMA 2022; 328: 184-197.
6. Bożek A, Nowak PF, Blukacz M. The relationship between spirituality, health-related behavior, and psychological well-being. Front Psychol 2020; 11: 1997.
7. Bravin AM, Trettene AD, Andrade LG, Popim RC. Benefits of spirituality and/or religiosity in patients with Chronic Kidney Disease: an integrative review. Rev Bras Enferm 2019; 72: 541-551.
8. Brown DR, Carney JS, Parrish MS, Klem JL. Assessing spirituality: The relationship between spirituality and mental health. J Spirituality Mental Health 2013; 15: 107-122.
9. Dehghani A, Khoramkish M, Isfahani SS. Challenges in the daily living activities of patients with multiple sclerosis: a qualitative content analysis. Int J Community Based Nurs Midwifery 2019; 7: 201-210.
10. Desborough J, Brunoro C, Parkinson A, et al. ‘It struck at the heart of who I thought I was’: A meta-synthesis of the qualitative literature examining the experiences of people with multiple sclerosis. Health Expect 2020; 23: 1007-1027.
11. Dobson R, Giovannoni G. Multiple sclerosis – a review. Eur J Neurol 2019; 26: 27-40.
12. Farahaninia M, Abbasi M, Givari A, Haghani H. Nursing students’ spiritual well-being and their perspectives towards spirituality and spiritual care perspectives. Iran J Nurs 2006; 18: 7-14.
13. Ghafari S, Ahmadi F, Nabavi M, Memarian R. Effects of applying progressive muscle relaxation technique on depression, anxiety and stress of multiple sclerosis patients in Iran National MS Society. Res Med 2008; 32: 45-53.
14. Ghodspour Z, Najafi M, Rahimian Boogar I. Effectiveness of mindfulness-based cognitive therapy on psychological aspects of quality of life, depression, anxiety, and stress among patients with multiple sclerosis. Pract Clin Psychol 2018; 6: 215-222.
15. Hanna M, Strober LB. Anxiety and depression in Multiple Sclerosis (MS): Antecedents, consequences, and differential impact on well-being and quality of life. Mult Scler Relat Disord 2020; 44: 102261.
16. Homayuni A, Hosseini Z, Abedini S. Explaining stress coping behaviors in patients with multiple sclerosis based on the PRECEDE model: a qualitative directed content analysis. BMC Psychiatry 2021a; 21: 631.
17. Homayuni A, Abedini S, Hosseini Z, et al. Explaining the facilitators of quality of life in patients with multiple sclerosis: a qualitative study. BMC Neurol 2021b; 21: 193.
18. Howard LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry 2020; 19: 313-327.
19. Iranms. (2018). http://iranms.ir/fa/news/8/. Iran MS Society.
20. Juškienė V. Spiritual health as an integral component of human wellbeing. Sveikatos ir socialinių mokslų taikomieji tyrimai: sandūra ir sąveika 2016; 13: 3-13.
21. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995; 33: 335-343.
22. Lucchetti G, Koenig HG, Lucchetti AL. Spirituality, religiousness, and mental health: A review of the current scientific evidence. World J Clin Cases 2021; 9: 7620-7631.
23. Mahdizadeh A, Lokzadeh S, Riyahi A, et al. The Investigation of factors affecting the gait of the patients suffering from multiple sclerosis. Arch Rehabil 2019; 20: 64-73.
24. Martínez BB, Custódio RP. Relationship between mental health and spiritual wellbeing among hemodialysis patients: a correlation study. Sao Paulo Med J 2014; 132: 23-27.
25. McNulty K, Livneh H, Wilson LM. Perceived uncertainty, spiritual well-being, and psychosocial adaptation in individuals with multiple sclerosis. Rehabil Psychol 2004; 49: 91.
26. Milner K, Crawford P, Edgley A, et al. The experiences of spirituality among adults with mental health difficulties: a qualitative systematic review. Epidemiol Psychiatr Sci 2020; 29: e34.
27. Paloutzian RF, Ellison CW. Loneliness, spiritual well-being and quality of life. In: Peplau LA, Perlman D (Eds.). Loneliness: A sourcebook of current theory, research and therapy. Wiley Interscience, New York 1982.
28. Perkins D, Schubert V, Simonová H, et al. Influence of context and setting on the mental health and wellbeing outcomes of ayahuasca drinkers: Results of a large international survey. Front Pharmacol 2021; 12: 623979.
29. Senmar M, Razaghpoor A, Mousavi AS, et al. Psychological symptoms in patients on dialysis and their relationship with spiritual well-being. Florence Nightingale J Nurs 2020; 28: 243-249.
30. Scherer JS, Milazzo KC, Hebert PL, et al. Association between self-reported importance of religious or spiritual beliefs and end-of-life care preferences among people receiving dialysis. JAMA Netw Open 2021; 4: e2119355.
31. Skrzypińska K. Does spiritual intelligence (SI) exist? A theoretical investigation of a tool useful for finding the meaning of life. J Relig Health 2021; 60: 500-516.
32. Smith TB, McCullough ME, Poll J. Religiousness and depression: evidence for a main effect and the moderating influence of stressful life events. Psychol Bull 2003; 129: 614-636.
33. Ramezani N, Ashtari F, Bastami EA, et al. Fear and anxiety in patients with multiple sclerosis during COVID-19 pandemic; report of an Iranian population. Mult Scler Relat Disord 2021; 50: 102798.
34. Tirgari B, Khaksari M, Soltani Z, et al. Spiritual well-being in patients with chronic diseases: A systematic review and meta-analysis. J Relig Health 2022; 61: 3969-3987.
35. Wilson CS, Forchheimer M, Heinemann AW, et al. Assessment of the relationship of spiritual well-being to depression and quality of life for persons with spinal cord injury. Disabil Rehabil 2017; 39: 491-496.
36. Yamada AM, Lukoff D, Lim CS, Mancuso LL. Integrating spirituality and mental health: Perspectives of adults receiving public mental health services in California. Psychol Relig Spiritual 2020; 12: 276.
37. Zare A, Bahia NJ, Eidy F, et al. The relationship between spiritual well-being, mental health, and quality of life in cancer patients receiving chemotherapy. J Family Med Prim Care 2019; 8: 1701-1705.
Copyright: © 2024 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
© 2024 Termedia Sp. z o.o.
Developed by Bentus.