The Mediating Role of Spiritual Distress and Spiritual Coping in the Relationship Between Stressful Life Events and Generalized Anxiety Disorder

Document Type : Original Article

Authors

Department of Psychology, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran.

Abstract

Introduction: Generalized Anxiety Disorder (GAD) is characterized by chronic, persistent, and excessive worry and anxiety. Individuals with GAD often find it difficult to control their worries and may experience symptoms such as fatigue, muscle tension, restlessness, difficulty concentrating, irritability, and disturbed sleep. This disorder is common and can be debilitating, influenced by various factors. Therefore, the present study aims to investigate the roles of spiritual distress and spiritual coping as mediators in the relationship between stressful life events and GAD.
Method: This research was a fundamental, quantitative, cross-sectional, and descriptive correlational study. The statistical population consisted of undergraduate students from the Islamic Azad University, Neyshabur branch, during the 2023–2024 academic year. The sample included 308 undergraduate students selected from three faculties: Humanities, Medical Sciences, and Engineering. Data were collected using the Generalized Anxiety Disorder Scale (GAD-7), the Stressful Life Events Questionnaire (SLEQ), the Spiritual Distress Scale (SDS), and the Spiritual Coping Questionnaire (SCQ). The data were analyzed using SPSS version 26 and LISREL version 8.8, employing path analysis.
Results: The average age of the participants was 20.99 years. The findings indicated a positive correlation between stressful life events, spiritual distress, negative spiritual coping, and generalized anxiety disorder (p < 0.05). The model examining the mediating role of spiritual distress and spiritual coping in the relationship between stressful life events and generalized anxiety disorder demonstrated a good fit (CFI = 0.95, NFI = 0.95, NNFI = 0.95, IFI = 0.95, RMSEA = 0.078). Additionally, the indirect effect of stressful life events on generalized anxiety disorder, mediated by spiritual distress and negative spiritual coping, was significant (p < 0.05).
Discussion and Conclusion: The research findings highlight the significant role of spiritual distress and spiritual coping in the relationship between stressful life events and generalized anxiety disorder among students. Addressing these factors within the field of psychopathology and developing targeted prevention and intervention programs can be beneficial.

Keywords

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fifth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2022.
  2. Newman, M. G., Basterfield, C., Erickson, T. M., Caulley, E., Przeworski, A., Llera, S. J. Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts. Expert Rev Neurother, 2022; 22(9): 751-70. https://doi.org/10.1080/14737175.2022.2125800
  3. DeMartini, J., Patel. G., Fancher, T. L. Generalized anxiety disorder. Ann Intern Med, 2019; 170(7): ITC49-ITC64. https://doi.org/10.7326/aitc201904020
  4. Pour, H., Mansouri, A. The mediating role of worry and rumination in the relationship between behavioral brain systems and generalized anxiety disorder in students. Clinical Psychology and Personality, 2021; 19(1): 121-30. https://doi.org/10.22070/cpap.2020.3047[In Persian]
  5. Zhao, L. Personality traits that associated with generalized anxiety disorder among PhD students. Acta Psychol (Amst). 2023; 240:104033. https://doi.org/10.1016/j.actpsy.2023.104004
  6. Tinsae, T., Shumet, S., Azale, T., et al. Exposure to stress-full life events and help-seeking behaviors among reproductive-age women in Northwest Ethiopia: Community-based cross-sectional study. J Affect Disord, 2024; 346: 310-16. https://doi.org/10.1016/j.jad.2023.11.011
  7. Cohen, S., Murphy, M. L. M., Prather, A. A. Ten surprising facts about stressful life events and disease risk. Annu Rev Psychol, 2019; 70: 577-97. https://doi.org/10.1146/annurev-psych-010418-102857
  8. Leenderts, E. Is there a moderating effect of parenting on the relation between negative life events and generalized anxiety in adolescence? Department of Child and Adolescent Psychology. Tilburg University; 2015-2016. http://arno.uvt.nl/show.cgi?fid=144147
  9. Lowe, S. R., Joshi, S., Galea, S., et al. Pathways from assaultive violence to post-traumatic stress, depression, and generalized anxiety symptoms through stressful life events: longitudinal mediation models. Psychol Med, 2017; 47(14): 2556-66. https://doi.org/10.1017/s0033291717001143
  10. de Mello, D. B., Trettim, J. P., da Cunha, G. K., et al. Generalized anxiety disorder, depressive symptoms and the occurrence of stressors events in a probabilistic sample of pregnant women. Psychiatr Q, 2021; 92(1): 123-33. https://doi.org/10.1007/s11126-020-09763-0
  11. Arul, A. S. Study of life events and personality dimensions in generalized anxiety disorder. J Clin Diagn Res, 2016; 10(4): VC05-VC09. https://doi.org/10.7860/JCDR/2016/18123.7652
  12. Shrestha, R. Stressful life events and coping strategies among patients with generalized anxiety disorders. Journal of Institute of Medicine Nepal, 2015; 37(3); 112. https://doi.org/10.59779/jiomnepal.939
  13. Mansouri, A., Khodayari Fard, M., Besharat, M., Gholamali Lavasani, M. Moderating and mediating role of spiritual coping and cognitive emotion regulation strategies in the relationship between transdiagnostic factors and symptoms of generalized anxiety disorder: Developing a conceptual model. J Res Behav Sci, 2018; 16(2): 130-42. http://dx.doi.org/10.52547/rbs.16.2.130 [In Persian]
  14. Herdman, T., Kamitsuru, S., Lopes, C. T. Nursing diagnoses: Definitions and classification 2021–2023. Thieme; 2021.
  15. Klimasiński, M., Baum, E., Praczyk, J., Ziemkiewicz, M., Springer, D., Cofta, S., Wieczorowska-Tobis, K. Spiritual distress and spiritual needs of chronically Ill patients in Poland: A cross-sectional study. Int J Environ Res Public Health, 2022; 19(9): 5512. https://doi.org/10.3390/ijerph19095512
  16. Cipta, A., Turner, B., Haupt, E. C., et al. Spiritual distress: symptoms, quality of life and hospital utilisation in home-based palliative care. BMJ Supportive & Palliative Care, 2021; 11: 322-8. https://doi.org/10.1136/bmjspcare-2021-003090
  17. Harris, J. I., Usset, T., Krause, L., et al. Spiritual/Religious Distress Is Associated with Pain Catastrophizing and Interference in Veterans with Chronic Pain. Pain Med, 2018; 19(4): 757-63. https://doi.org/10.1093/pm/pnx225
  18. Kopacz, M. S., Hoffmire, C. A, Morley, S. W., Vance, C. G. Using a spiritual distress scale to assess suicide risk in Veterans: An exploratory study. Pastoral Psychology, 2015; 64(3): 381-90. https://psycnet.apa.org/doi/10.1007/s11089-014-0633-1
  19. Berg, G. The relationship between spiritual distress, PTSD and depression in Vietnam combat veterans. J Pastoral Care Counsel, 2011; 65(1-2): 1-11. https://doi.org/10.1177/154230501106500106
  20. Amjad, F., Bokharey, I. Z. Comparison of spiritual well-being and coping strategies of patients with generalized anxiety disorder and with minor general medical conditions. J Relig Health, 2015; 54(2): 524-59. https://doi.org/10.1007/s10943-014-9834-2 [In Persian]
  21. Abdel-Hamid Zaki, R., Sayed Mohammed, H., Ezz El-Din Prince, H. Relationship between levels of anxiety, self-compassion, and spiritual wellbeing among patients with generalized anxiety disorder. Egyptian Journal of Health Care, 2022; 13(1): 517-27. https://doi.org/10.21608/ejhc.2022.219056 [In Persian]
  22. Pargament, K. I. The psychology of religion and coping: Theory, research, practice. New York: The Guilford Press; 2001.
  23. Charzynska, E. Multidimensional approach toward spiritual coping: construction and validation of the Spiritual Coping Questionnaire (SCQ). J Relig Health, 2015; 54(5): 1629-46. https://doi.org/10.1007/s10943-014-9892-5
  24. Amjad, F., Bokharey, I. Z. The impact of spiritual wellbeing and coping strategies on patients with generalized anxiety disorder. J Muslim Ment Health, 2014; 8(1): 21-38. https://doi.org/10.3998/jmmh.10381607.0008.102 [In Persian]
  25. Khodayarifard, M., Mansouri, A., Besharat, M. A., Gholamali Lavasani, M. The relationship between spiritual coping and generalized anxiety disorder symptoms in students. MEJDS, 2018; 8: 91. http://dorl.net/dor/20.1001.1.23222840.1397.8.0.56.1 [In Persian]
  26. Stanley, M. A., Bush, A. L., Camp, M. E, et al. Older adults' preferences for religion/spirituality in treatment for anxiety and depression. Aging Ment Health, 2011; 15(3): 334-43. https://doi.org/10.1080/13607863.2010.519326
  27. Ayten, A., Karagöz, S. Religiosity, spirituality, forgiveness, religious coping as predictors of life satisfaction and generalized anxiety: A quantitative study on Turkish Muslim university students. Spiritual Psychology and Counseling, 2021; 6(1): 47-58. https://doi.org/10.37898/spc.2021.6.1.130
  28. Francis, B., Gill, J. S, Yit Han, N., et al. Religious coping, religiosity, depression and anxiety among medical students in a multi-religious setting. Int J Environ Res Public Health, 2019; 16(2): 259. https://doi.org/10.3390/ijerph16020259
  29. Ai, A. L., Weiss, S. I., Fincham, F. D. Family factors contribute to general anxiety disorder and suicidal ideation among Latina Americans. Womens Health Issues, 2014; 24(3): e345-52. https://doi.org/10.1016/j.whi.2014.02.008
  30. Ai, A. L., Pappas, C., Simonsen, E. Risk and protective factors for three major mental health problems among Latino American men nationwide. Am J Mens Health, 2015; 9(1): 64-75. https://doi.org/10.1177/1557988314528533
  31. Graça, L., Brandão, T. Religious/spiritual coping, emotion regulation, psychological well-being, and life satisfaction among university students. J Psychol Theol, 2024; 52(3): 342-58. https://doi.org/10.1177/00916471231223920
  32. Mansouri, M., Tarimoradi, A., Mansouri, A., Zam, F., Bolghan-Abadi, M. Predicting of nonsuicidal self-injury in adolescents using stressful life events, maladaptive schema and spiritual coping. J Neyshabur Univ Med Sci, 2022; 10(1): 143-55. http://journal.nums.ac.ir/article-1-1232-fa.html [In Persian]
  33. Meyers, L. S., Gamst, G. C., Guarino, A. J. Applied multivariate research: Design and interpretation. Sage; 2016.
  34. Spitzer, R. L., Kroenke, K., Williams, J. B., Löwe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med, 2006; 166(10): 1092-7. https://doi.org/10.1001/archinte.166.10.1092
  35. Naeinian, M., Shaeiri, M., Sharif, M., Hadian, M. To study reliability and validity for a brief measure for assessing Generalized Anxiety Disorder (GAD-7). Clinical Psychology and Personality, 2011; 9(1): 41-50. https://dorl.net/dor/20.1001.1.23452188.1390.9.1.5.7 [In Persian]
  36. Green, B. L., Chung, J. Y., Daroowalla, A., Kaltman, S., Debenedictis, C. Evaluating the cultural validity of the stressful life events screening questionnaire. Violence Against Women, 2006; 12(12): 1191-1213. https://doi.org/10.1177/1077801206294534
  37. Goodman, L. A., Corcoran, C., Turner, K., Yuan, N., Green, B. L. Assessing traumatic event exposure: general issues and preliminary findings for the Stressful Life Events Screening Questionnaire. J Trauma Stress, 1998; 11(3): 521-42. https://doi.org/10.1023/a:1024456713321
  38. Sabouri, M., Mansouri, A. The relationship between stressful events and psychological distress in women with substance use disorder: The moderating roles of resilience and mindfulness. Etiadpajohi, 2022; 16(65): 27-48. http://dx.doi.org/10.52547/etiadpajohi.16.65.27 [In Persian]
  39. Khodayarifard, M., Mansouri, A., Besharat, M. A., Gholamali Lavasani M. The standardization of spiritual coping questionnaire in student population. JFMH, 2019; 21(4): 221-31. https://doi.org/10.22038/jfmh.2019.14397 [In Persian]
  40. Ku, Y. L., Kuo, S. M., Yao, C. Y. Establishing the validity of a spiritual distress scale for cancer patients hospitalized in southern Taiwan. Int J Palliat Nurs, 2010; 16(3): 134-38. https://doi.org/10.12968/ijpn.2010.16.3.47325
  41. Ghayor Kazemi, F., Shahhabizadeh, F., Safara, F., Shahidsales, M. Comparing the effects of transdiagnostic intervention and mindfulness-based schema therapy on spiritual distress in women with breast cancer: A clinical trial. Health Spiritual Med Ethics, 2022; 9(2): 63-74. http://dx.doi.org/10.32598/hsmej.9.2.418.1 [In Persian]
  42. Lalani, N. Spiritual distress among novice nurses during role transition at a university teaching hospital in Pakistan. Nurs Pract Today, 2019; 6(2): 55-62. https://doi.org/10.18502/npt.v6i2.909
  43. Khodayarifard, M., Mansouri, A., Besharat, M. A., Gholamali-Lavasani, M. Religiously and spiritually integrated treatments and generalized anxiety disorder. J Res Behav Sci, 2017; 15(1): 126-34. http://dorl.net/dor/20.1001.1.17352029.1396.15.1.17.6 [In Persian]

Files

Share

How to cite

Statistics