|Year : 2019 | Volume
| Issue : 2 | Page : 137-142
Lack of association between religiosity/spirituality and mental well being among medical students and interns
Tabitha Gheevarghese1, Parthasarathy Ramamurthy2, Manikandan Mani3, Pradeep Thilakan2
1 MBBS Student, Pondicherry Institute of Medical Sciences, Puducherry, India
2 Department of Psychiatry, Pondicherry Institute of Medical Sciences, Puducherry, India
3 Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
|Date of Submission||19-Mar-2019|
|Date of Decision||01-Jul-2019|
|Date of Acceptance||18-Jul-2019|
|Date of Web Publication||18-Dec-2019|
Dr. Parthasarathy Ramamurthy
Department of Psychiatry, Pondicherry Institute of Medical Sciences (A Unit of Madras Medical Mission), Kalathumettupathai, Ganapathichettikulam, Village No. 20, Kalapet, Puducherry - 605 014
Source of Support: None, Conflict of Interest: None
Background: High subjective well-being causes better health and longevity. Religiosity has been shown to be positively associated with subjective well-being of medical students. The composition and content of religion is different in India, and hence the role of religiosity and spirituality on mental well-being of Indian medical students requires exploration. The present study was conducted to assess the relationship of religiosity and spirituality with mental well-being among medical students and interns. Methods: Warwick–Edinburgh Mental Well-Being Scale (WEMWBS), Centrality of Religiosity Scale (CRS), and Intrinsic Spirituality Scale (ISS) were administered to medical students at a private medical college in South India. The association of religiosity and spirituality with mental well-being was analyzed using Pearson's correlation analysis. Results: There was no correlation between WEMWBS and CRS scores. Similarly, there was no correlation of WEMWBS score with ISS score. Among Christian and Muslim medical students, there was a significant correlation between WEMWBS and ISS scores. No such correlation was found among Hindu medical students. Conclusion: Overall, there was no association of mental well-being with religiosity and spirituality among medical students. However, there were significant differences in this association among students with different religious affiliations. Among Christian and Muslim medical students, there was a positive association of mental well-being with spirituality but not with religiosity. No such association was found among Hindu medical students.
Keywords: Happiness, psychological well-being, subjective well-being
|How to cite this article:|
Gheevarghese T, Ramamurthy P, Mani M, Thilakan P. Lack of association between religiosity/spirituality and mental well being among medical students and interns. Ann Indian Psychiatry 2019;3:137-42
|How to cite this URL:|
Gheevarghese T, Ramamurthy P, Mani M, Thilakan P. Lack of association between religiosity/spirituality and mental well being among medical students and interns. Ann Indian Psychiatry [serial online] 2019 [cited 2020 Apr 9];3:137-42. Available from: http://www.anip.co.in/text.asp?2019/3/2/137/273372
| Introduction|| |
High subjective well-being (such as life satisfaction, absence of negative emotions, optimism, and positive emotions) causes better health and longevity. In the US general population, among other factors such as higher income, being married, higher education, job satisfaction, and marital happiness, high religiosity is associated with high subjective well-being.
Religion is described as an organized system of beliefs, practices, rituals, and symbols designed to facilitate closeness to the sacred or transcendent (God, higher power, or ultimate truth/reality). On the other hand, spirituality is defined as the personal quest for understanding answers to the ultimate questions about life, about meaning, and about a relationship with the sacred or transcendent, which may (or may not) lead to or arise from the development of religious rituals and the formation of a community.
The mental stress faced by medical students during the course is extensive and unique, and factors that may affect their mental health may have implications in their future role as health-care providers. The role of religiosity and spirituality on the subjective well-being of medical students has been studied in different countries across the world. Most studies found that religiosity and spirituality were strong predictors of psychological well-being among medical students.,,,, There is some conflicting evidence suggesting that religiosity is associated with anxiety among Israeli medical students. The above studies were conducted among medical students with predominantly Christian,, Muslim,, or Jewish  affiliations.
A study from South India found that spiritual inclination among medical students was negatively associated with state anger, trait anger, and anger expression. However, there is limited information on the role of religiosity and spirituality in the mental well-being of Indian medical students. There are differences in the religious composition and content of religions in India and therefore, the results of the studies done in other countries will not be applicable to Indian medical students. This study was conducted with the aim of assessing the relationship of religiosity and spirituality with mental well-being among medical students and interns.
| Subjects and Methods|| |
The present study was a cross-sectional observational study conducted among the undergraduate medical students and interns of a private medical college in South India. The study was approved by the institute's ethics committee. Data collection was conducted in the months of July and August, 2018, using semi-structured pro formas, using pen and paper. All the final-year M.B.B.S. students and interns were included in this study. Students of both genders and all available socioeconomic strata in the study population were included in the study. No specific exclusion criteria were specified. The list of students who were in their final year or internship was obtained from the institute's records. These students were approached in separate groups (averaging three students at a time for interns and fifty students for final years according to their schedules) during working hours with the permission of the concerned faculty, and the details of the study were explained to them. An opportunity to clarify the doubts they had regarding the study was provided during that time. Written informed consent was obtained from the students who expressed willingness to participate in the study.
The participants then filled a semi-structured pro forma which gathered details regarding the sociodemographic profile, religious affiliation, presence of chronic medical/psychiatric illnesses, and regular use of substances. Then, the participants completed three self-administered questionnaires that assessed their mental well-being (Warwick–Edinburgh Mental Well-Being Scale [WEMWBS]), religiosity (Centrality of Religiosity Scale [CRS]), and spirituality (Intrinsic Spirituality Scale 2). Anonymity was maintained throughout the period of the study. The response sheets were collected from the participants, and they were thanked for their participation.
The questionnaires used in this study are described briefly as follows:
- WEMWBS: This is a 14-item scale assessing the mental well-being of the participants in the preceding 2 weeks. Each item is scored on a Likert scale from 1 to 5. The total score is calculated by summing the individual item scores. The participant could score a minimum of 14 and a maximum of 70 on this scale. Higher scores indicate greater mental well-being and vice versa.
- CRS: The religiosity of the participants was assessed using this 15-item scale, with each item scored from 1 to 5. This allows the CRS scores to range from 15 to 75. Among these 15 questions, there are three questions to assess each of the dimensions of religiosity, namely, intellectual dimension, ideology, public practice, private practice, and religious experience.
- ISS: Spirituality was assessed through this 6-item scale. Each item has a Likert score ranging from 0 to 10. Respondents' level of intrinsic spirituality is indicated by taking a sum of their scores on the six items. A score of 0 represents individuals for whom spirituality was not operative in their life as a motivating factor. A score of 60 represents individuals who were motivated by spirituality to the highest degree possible.
Statistical methods used
Statistical analysis was done using Statistical Package for Social Sciences (SPSS) software version 20 (IBM Corp., Armonk, NY, USA). Categorical data were summarized in terms of frequencies and percentages. Mean and standard deviation were calculated for the continuous variables. Pearson's correlation was done for evaluating the relationship of mental well-being (WEMWBS score) with religiosity (CRS score) and spirituality (ISS score). Correlation analyses between mental well-being and the different dimensions of religiosity were also done. Later, subgroup analysis was done using the same methods for different religious affiliations of the participants. P < 0.05 was considered to be statistically significant.
| Results|| |
Out of the target population of 283 medical students, 213 participated in the study (response rate = 75.2%). Out of these 213 students, 117 (54.9%) students were final-year students and 96 (45%) were interns [Figure 1].
The mean age of the participants was 22.1 ± 1 years. There was a female preponderance of 63.4%. Most of the students were unmarried (97.2%), were belonging to nuclear families (85.2%), and were from higher socioeconomic status (56.3%) [Table 1].
|Table 1: Sociodemographic details and clinical profile of the study participants|
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Ten students (4.7%) reported having a chronic medical illness, of which asthma was the most common. Five students (2.3%) reported a psychiatric illness, of which depression was the most common. Twenty-one students (9.9%) said that they have a regular habit of consuming an addictive substance – the most common being alcohol [Table 1].
Out of the 213 participants, 145 students (68.1%) identified themselves as Hindus and 53 students (24.9%) identified themselves as Christians. Together, Hinduism and Christianity were the most commonly practiced religions by the participants of this study [Table 2].
Mental well-being, religiosity, and spirituality scores
On the WEMWBS, the mean score of the participants was found to be 44.46 ± 9.27. On the CRS, the mean score of the participants was 49.83 ± 13.06, and on the ISS, the mean score was 31.74 ± 14.51. The mean scores of the various dimensions of CRS are tabulated in [Table 3].
|Table 3: Mean scores of the various dimensions of religiosity measured by the Centrality of Religiosity Scale|
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Association of mental well-being with religiosity and spirituality
A Pearson's product-moment correlation coefficient was computed to assess the relationship between WEMWBS score and CRS. There was no correlation between the two variables, r (213) = 0.068, P = 0.320. A scatterplot summarizes the results [Figure 2]. Overall, there was no correlation between mental well-being and religiosity among the medical students. Similarly, there was no significant correlation between mental well-being (as measured by the WEMWBS) and individual dimensions of religiosity (as measured by the CRS) among the medical students.
|Figure 2: Scatter diagram depicting lack of association between Warwick Edinburgh mental well-being scale scores and centrality of religiosity scale scores of the participants|
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Pearson's correlation coefficient for WEMWBS score with ISS score did not reveal any statistically significant correlation between these two variables. r (213) = 0.127, P = 0.065. A scatterplot summarizes the results [Figure 3]. Overall, there was no correlation between mental well-being and spirituality among the medical students.
|Figure 3: Scatter diagram depicting lack of association between Warwick Edinburgh mental well-being scale scores and intrinsic spirituality scale scores of the participants|
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A highly significant correlation was found between religiosity as measured by the CRS score and spirituality as measured by the ISS score, r (213) = 0.788, P < 0.001 [Figure 4].
|Figure 4: Scatter diagram depicting strong positive association between centrality of religiosity scale scores and intrinsic spirituality scale scores of the participants|
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The participants were divided into subgroups based on their religious affiliation, and similar analyses were carried out to assess the relationship of mental well-being with religiosity and spirituality. Among Hindu medical students, there was no significant association of mental well-being with religiosity and spirituality. Among Christian medical students, there was a moderate positive association of mental well-being and spirituality. Among Muslim medical students, there was a strong positive association of mental well-being with spirituality but not with religiosity. The correlation coefficients and their significance values are summarized in [Table 4].
|Table 4: Relationship of mental well-being (Warwick-Edinburgh Mental Well-Being Scale) with religiosity (Centrality of Religiosity Scale) and spirituality (Intrinsic Spirituality Scale) among medical students with different religious affiliations|
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Gender differences in the scores of mental well-being, religiosity, and spirituality were explored. Female medical students had significantly higher scores on religiosity and spirituality scales compared to male medical students. No difference in mental well-being scores was found between both the genders. There was no association between religiosity/spirituality scores with mental well-being score when both the genders were analyzed separately. The results are summarized in [Table 5].
|Table 5: Gender differences in mental well-being, religiosity, and spirituality among medical students|
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| Discussion|| |
The present study was conducted to assess the relationship of religiosity and spirituality with mental well-being among medical students. Overall, there was no association of mental well-being with religiosity and spirituality among medical students.
Previous studies that explored this association found predominantly positive associations between psychological well-being and religiosity/spirituality. A study conducted in Pakistan among Muslim medical students revealed that religiosity was a strong predictor of psychological well-being. Similarly, in an Iranian study among Muslim medical students, it was found that spirituality strongly predicted psychological well-being, and internal religious orientation was a strong mediator in the relationship between spirituality and psychological well-being. In a study from the USA, among predominantly Christian medical students, an inverse correlation between the measures of spirituality and psychological distress/burnout and a positive correlation between life satisfaction and spirituality were reported. Among Jewish medical students in Israel, a positive correlation between religiosity and anxiety was found among medical students. Although anxiety and psychological well-being are different constructs, this study found an association between religiosity and negative emotional state among medical students.
The difference in the findings of the present study and the most common findings in the literature could be attributed to differences in religious affiliation and the differences in religious practice between the populations studied. The finding of a positive association between spirituality and mental well-being among Christian and Muslim participants of this study lends credence to this theory. The difference could be due to differences in social support, respect, and meaning in life, which are closely tied to religious practices in Christianity and Islam, whereas these are not so closely tied in Hinduism. This study was done among various religions, keeping in mind that there are differences in the methodology by which various religions are practiced. While the levels of religiosity might be similar in two individuals belonging to different religions, there may be differences in their practices, beliefs, or social involvements that may influence the results of the study.
In the present study, there was a strong positive correlation between CRS score and ISS score. Such a strong correlation between religiosity score and spirituality score raises questions about how the participants interpreted the questionnaire on spirituality and whether medical students achieve their spiritual needs through their religion predominantly.
There is growing interest and effort in monitoring subjective well-being across several countries. The United Kingdom government has introduced the Measuring National Well-Being program in the year 2010, and this program included measures on the subjective well-being of the nation. Bhutan has periodically assessed Gross National Happiness Index and has declared that this would guide her policies. There are similar efforts in the USA, Chile, Japan, and Australia. With such laudable efforts in the global scenario, it is indeed pertinent and important for medical colleges across the world to assess mental well-being of medical students and promote efforts to improve it in the budding doctors who will serve as pillars of the health-care system in future.
The implications of this study lie in finding factors that may influence the mental health of medical students who will provide health care in future. Protective factors to their psychological well-being need to be assessed, as any factors found that they use to cope with the stresses they face as future medical practitioners change the quality of health care they provide. These factors may then be used to design interventions that improve mental health in medical students and doctors, which will improve the effectiveness of medical education and ultimately, patient care.
The notable strength of this study was that students belonging to the three most commonly practiced religions in India were included in the study. The use of the CRS which assessed five different dimensions of religiosity was also an added strength to the study.
This study also had a few limitations. As the sample comprises solely of medical students, the results cannot be generalized to the general population. As there was no adequate representation of all the religions practiced in India, for example Buddhism and Jainism, the results cannot be extrapolated to medical students belonging to those religions. As this was a cross-sectional study, no conclusions regarding causality can be drawn from the findings of the study. Furthermore, the religious practices, beliefs, and social involvement were not assessed in detail in the present study.
In future, studies that can identify factors associated with the mental well-being of medical students need to be done. In addition, longitudinal studies that can assess the causal direction between mental well-being and the associated factors would be useful to provide guidance toward efforts to improve mental well-being.
| Conclusion|| |
Overall, there was no association of mental well-being with religiosity and spirituality among medical students and interns. However, there were significant differences in this association among students with different religious affiliations. Among Christian and Muslim medical students, there was a positive association of mental well-being with spirituality but not with religiosity. No such association was found among Hindu medical students.
This study was approved by Institutional Ethics Committee with reference number IEC/RC/18/23 obtained on 2nd May 2018.
Declaration of Patient Consent
Patient consent statement was taken from each patient as per institutional ethics committee approval along with consent taken for participation in the study and publication of the scientific results / clinical information /image without revealing their identity, name or initials. The patient is aware that though confidentiality would be maintained anonymity cannot be guaranteed.
Financial support and sponsorship
The first author received a stipend from the Indian Council of Medical Research under Short Term Studentship programme – Reference Id: 2018–00314. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]