Health, Spirituality and Medical Ethics

Hossein Jenaabadi1* , Khatereh Amiri Bahrami1
1. Department of Psychology and Educational Sciences, Faculty of Educational Sciences and Psychology, University of Sistan and Baluchestan, Zahedan, Iran.
* Corresponding Author:
Hossein Jenaabadi, PhD.
Address: Department of Psychology and Educational Sciences, Sistan and Baluchestan University, Zahedan, Iran.
Phone: +98 (915) 3499137
E-mail: hjenaabadi@ped.usb.ac.ir
Research Paper:
The Relationship Between Spiritual Health and School
Burnout With Mediating Role of Social Support
Background and Objectives: In the past few decades, spiritual health, as one of the dimensions
of health besides physical, mental, and social health, has drawn the attention of psychologists and
mental health professionals more than ever. However, there is a research gap in our country, so
the primary purpose of this study was to investigate the relationship between spiritual health and
school burnout with the mediating role of social support.
Methods: This descriptive correlational research used the path analysis method. The statistical
population comprised all sixth-grade female students (600 people) in Rudbar City, Iran, in the
academic year 2020-2021. The sample size is calculated with the Morgan table (234 people). The
samples were recruited by a simple random sampling method, and the research tools were the
related questionnaire. The content validity and reliability of this research were confirmed. The
tests were analyzed according to the research questions by path analysis, the Pearson correlation
coefficient, and the 1-sample t test. The obtained data were analyzed in SPSS v. 26 software and
LISREL software v. 8.8.
Results: There is a significant relationship between spiritual health and school burnout (P=0.01).
Also, there is a significant relationship between spiritual health and social support (P=0.01). The
t values obtained from the studied paths have P-values less than 0.05, so the indirect effects
were statistically significant. So, social support has had an indirect impact on spiritual health and
academic burnout.
Conclusion: One of the influential factors in reducing school burnout and increasing spiritual
health is the social support perceived by students.
A B S T R A C T
Keywords:
Spiritual health, School
burnout, Perceived social
support
Please cite this article as Jenaabadi H, Amiri Bahrami K. The Relationship Between Spiritual Health and School Burnout
With Mediating Role of Social Support. Health, Spirituality and Medical Ethics Journal. 2021; 8(3):163-170. http://dx.doi.
org/10.32598/hsmej.8.3.5
: http://dx.doi.org/10.32598/hsmej.8.3.5
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Article info:
Received: 17 Jan 2021
Accepted: 15 Aug 2021
Publish: 01 Sep 2021
164
September 2021. Volume 8. Number 3
Introduction
oday, most societies in all aspects have undergone
rapid and dramatic changes that
the effects of these changes on their physical
and mental health are very noticeable.
Encountering physical and mental problems
can cause acute and severe crises in people’s health
and increase their vulnerability; however, they can result
in personal and spiritual growth [1]. Since 47 years ago,
the results of extensive research showed the relationship
between religious and spiritual factors with physical indicators
and provided a more comprehensive and new
definition of health. These findings were gradually introduced
in scientific writings [2]. After several years that
the health concept has been analyzed based on specific
dimensions (physical health, mental health, and social
health), another important dimension of individual and
social life has been presented to health experts, which
can be called spiritual health [3].
School burnout is considered an obstacle to academic
achievement. With more stress and adverse consequences
in students’ lives, the quality and quantity of academic
performance are reduced. Prevention and coping with
students’ school burnout is one of the main problems of
any educational system. School burnout not only prevents
learners from academic achievement but also disrupts
their normal functioning in school and the learning
environment [4].
In contrast, social support for students is a vital issue.
Social support is the love, attention, and assistance that a
person receives from family members, friends, and others;
social support protects against stressful events. Inadequate
social support makes life adaption difficult for
students. It prevents them from accepting their various
roles in the family, school, and society, resulting in poor
physical, mental, and spiritual health [5]. According to
what was said, we sought to investigate the effect of
spiritual health on school burnout through a descriptive
correlational method of path analysis considering the
mediating role of social support in sixth-grade female
students in Rudbar City, Iran.
Methods
According to our research topic, this study was a descriptive-
correlational study with a path analysis method.
Also, it is an applied study in terms of its objectives.
The statistical population comprised all sixth-grade female
students in Rudbar (600 people) studying in the
academic year 2020-2021. The statistical sample of this
study, according to Krejcie-Morgan’s table, comprised
234 sixth-grade female students in Rudbar who were selected
by a simple random sampling method. However,
300 questionnaires were distributed among students
online because of distance learning due to COVID-19
epidemics, of which 66 returned questionnaires were removed.
The researcher informed the people about their
right to leave the research and the absence of any obligation.
Then the questionnaires were distributed online,
and participants were asked to answer the questions
without any time limit and at any time. The research
tools included three standard questionnaires as follows:
Spiritual Health Questionnaire
The 20-item spiritual health questionnaire of Polutzin
and Ellison (1982) assesses the religious health of the
people with 10 questions (1, 3, 5, 7, 9, 11, 13, 15, 17, and
19) and their physical health with another 10 other questions
(2, 4, 6, 8, 10, 12, 14, 16, 18, and 20). The range
of spiritual health scores is between 20 and 120. The answers
to these questions are scored on a 6-point Likert
scale from “strongly disagree = 1” to “strongly agree =6”
[6]. The validity and reliability of this questionnaire have
been confirmed in various studies. In Iran, its α coefficient
was found 0.82 [7]. Also, in another study, the reliability
of this questionnaire was 0.85 using the Cronbach α [8].
Academic Burnout Questionnaire
This questionnaire was developed by Breso et al. in
2007. The academic burnout questionnaire assesses
three areas of school burnout: academic fatigue, academic
apathy, and academic inefficiency. The questionnaire
consists of 15 expressions scored on a 5-point
Likert scale from “completely disagree” to “completely
agree”. The reliability values of the questionnaire were
calculated by its developers as 0.82, 0.70, and 0.75 for
the three burnout areas, respectively [9]. In a study, the
Cronbach α values were calculated at 0.85 for the whole
questionnaire and 0.77, 0.82, and 0.66 for the areas of
academic fatigue, academic apathy, and academic inefficiency,
respectively [10].
Social Support Questionnaire
This tool has been prepared by Zimeat et al. (1988) to
measure the social support perceived by family, friends,
and important people in a person’s life. It has 12 items,
and the respondents express their opinion on a 5-point
Likert scale from 1 for “strongly disagree” to 5 for
“strongly agree” [11]. Various studies have confirmed
T
Jenaabadi & Amiri. Relationship Between Spiritual Health and School Burnout. Health Spiritual Med Ethics J. 2021; 8(3):163-170
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September 2021. Volume 8. Number 3
the validity of this questionnaire, and one study reported
its internal reliability as 0.89 [12].
In the present study, to determine the validity of the
above questionnaires, they were provided to five professors
and experts in educational sciences. After their
review, the questionnaires were approved and used. To
determine the validity of these questionnaires, we used
the Cronbach α coefficient, which was calculated 0.92
for spiritual health, 0.90 for school burnout, and 0.86 for
social support. According to the research topic and the
method required for data analysis in this research, descriptive
and inferential statistics were used to analyze the
data. In descriptive statistics, mean and standard deviation
were used. In inferential statistics, the appropriate tests to
the research questions such as path analysis, the Pearson
correlation coefficient, and the 1-sample t test were used.
Results
The overall indicators of the goodness-of-fit test in
the path analysis indicate the overall fit of the proposed
model; if the Chi-square over the degree of freedom was
less than 3, it is desirable. Also, when the Root Mean
Square Error of Approximation (RMSEA) is less than
0.1, the model analysis and fit are desirable. Finally, the
closer the Goodness-of-Fit Index (GFI), Adjusted Goodness-
of-Fit Index (AGFI), Normed Fit Index (NFI),
Comparative Fit Index (CFI), and Nonnormed Fit Index
(NNFI) to 1, the better the model’s fit. According to the
obtained indices in the above table, the Chi-square index
over the degree of freedom is 275.50. Also, the values of
GFI, AGFI, NF, CFI, and NNFI fit indices are close to 1,
indicating that these indicators have achieved the necessary
standards. Therefore, it can be said that the model
has a good fit and is confirmed (Table 1). The results of
calculating the t statistics (t values) and the standard estimation
mode related to the path analysis of the variables
are shown (Figure 1).
Table 1 shows that the spiritual health variable has an
average and standard deviation of 95.36 and 11.10, respectively.
Also, the social support variable has a mean
and standard deviation of 46.22 and 10.74, and the
school burnout variable has a mean and standard deviation
of 27.85 and 3.17, respectively.
As seen in Table 2, the correlation of spiritual health
with social support (r=0.330) is positive and statistically
significant (P<0.01). The results also show that social
support can predict 0.105 of changes in spiritual health
(F=28.35, B=0.330, t=5.32, P<0.01).
Table 1. Descriptive statistics on spiritual health, social support, and school burnout
Variables Mean±SD Skewness Elongation
Spiritual health 95.36±11.10 -0.46 -0.82
Social support 46.22±10.74 -0.65 -0.52
School burnout 27.85±3.17 -0.98 -0.47
Figure 1. Path diagram related to the path coefficients of the research conceptual model
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The above diagrams show that the data are normal.
Also, the degree of skewness and elongation of the research
variables indicate that the data are normal.
As seen in Table 3, the correlation between spiritual
health and school burnout (r=-0.313) is negative, and
statistically significant (P<0.01). The results also show
that school burnout can predict 0.094 of changes in spiritual
health (F=13.25, B -0.313, t=-5.01, P<0.01).
The diagrams show that the data are normal. Also, the
degree of skewness and elongation of the research variables
indicate that the data are normal.
Table 4 presents the direct, indirect effects, and overall
standardized effect of spiritual health and school burnout
with the mediating role of social support. Spiritual
health directly affects social support and school burnout
by 0.33 and -0.13 values, respectively. It is also observed
that social support directly affects school burnout with
a -0.55 value. While it indirectly and through the mediating
role of school burnout affects spiritual health by
-0.18. The total effect (direct and indirect) was estimated
to be -0.51. Therefore, social support has indirectly affected
the spiritual health and school burnout of sixthgrade
female students in Rudbar City, Iran.
We used the 1-sample t test to assess the level of spiritual
health, social support, and school burnout of students.
As Table 5 shows, the variable of spiritual health is significant
(P<0.01) with t=34.93, df=233, and test value
=70. Since the average spiritual health is greater than the
test value, so the level of the spiritual health of sixth-grade
female students in Rudbar is at a high level. This finding
is consistent with the results of Lee et al. [13].
Table 5 also indicate that perceived social support is
significant (P<0.01) with t=14.55, df=233, and test value=
36. Since the average perceived social support is
higher than the test value, the perceived social support
of sixth-grade female students in Rudbar is high. This
finding is consistent with the results of Azizi Abargooei
et al. [10] and Chavoshian et al. [15].
The Table 5 also showed that school burnout is significant
(P<0.01) with t=-82.50, df=233, and test value= 45.
Since the average test burnout value is smaller than the
test value, the burnout rate of sixth-grade female students
in Rudbar is low. This finding is consistent with
the results of Sadeghian et al. and Pouratashi and Zamani
studies. But it does not agree with the results of
Ortorgota and Sivakersi. They concluded that the level
of burnout is high in students, especially girls.
Table 2. Summary of the spiritual health regression pattern with social support
Variables Correlation Coefficient
R2 Adjusted
R2
Non-standard
Beta
Standard
Beta t Sig.
Spiritual
health
Social support
0.330** 0.109 0.105 0.319 0.330 32.5 0.001
** P<0.01.
Figure 2. Normal p-p plot regression chart of spiritual health and social support
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September 2021. Volume 8. Number 3
Discussion
The primary purpose of this study was to investigate
the effect of spiritual health on school burnout with the
mediating role of social support for sixth-grade female
students in Rudbar City, Iran.
School burnout in educational settings is defined as a
feeling of tiredness due to the demand and requirements
of education (fatigue), having a pessimistic and uninterested
sense about the content and assignments (indifference),
and a sense of poor personal progress in academic
affairs (decreased personal self-efficacy). People with
school burnout often experience symptoms such as a
lack of interest in the educational materials, inability to
continue attending classes, frequent absences, non-participation
in class activities, a feeling of inability to learn
the courses, and ultimately academic failure [13].
Table 3. Summary of the pattern of spiritual health regression with social support and school burnout
Variables Correlation
Coefficient R2 Adjusted R2 Non-standard
Beta Standard Beta t Sig.
Spiritual
health
School burnout
-0.313** 0.098 -0.94 -0.179 -0.313 -5.01 0.001
** P<0.01.
Table 4. Estimation of direct, indirect and the total effect of spiritual health and school burnout with social support
Paths in the Final Pattern
Coefficients
Direct Indirect General effect Result
Spiritual health Social support 0.33** - 0.33** Confirmation
Spiritual health School burnout -0.13** - -0.13** Confirmation
Social support School burnout -0.55** - -0.55** Confirmation
Spiritual health Social support School burnout 0.33** -0.18** -0.51** Confirmation
** P<0.01.
Figure 3. Normal p-p plot regression chart of spiritual health and school burnout
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On the other hand, spiritual health is essential for humans,
especially for adolescents, because they are looking
for purpose, meaning, and identity in their lives. They are
in a time when issues like decision-making, inner peace,
self-awareness, and socio-moral compatibility are essential
to them. James (1997) believed that these issues urge
the necessity of teaching spiritual skills to adolescent students.
By learning these skills, students can understand
the meaning of their lives, follow rational and logical behaviors,
make their relationship with others human and
doctrinal, create a positive attitude towards themselves
and others, and increase their spiritual health. Some studies
suggest that without spiritual health, other biological,
psychological, and social dimensions may not function
properly or reach their maximum potential. Therefore, the
highest level of quality of life will not be achieved. In other
words, spiritual health harmonizes different aspects of
life and strengthens mental function and adaptation [14].
According to the obtained results In this study, higher
spiritual health can control students’ school burnout and
improve and grow their academic performance.
Chavoshian et al. found a significant relationship between
the components of social support and spiritual
health [15]. Al-Warani and Al-Radaydeh found a positive
and significant correlation between spiritual wellbeing
and perceived social support, and also between perceived
social support and life satisfaction. Besides, both
areas of spiritual wellbeing had positive and significant
correlations with all perceived sources of social support
[16]. The health of an individual is the foundation of the
health of society, and society plays a decisive role in the
health of individuals. The health status of individuals in
society affects their health and emotions in various ways,
as well as the economic and social indicators of society.
Therefore, ensuring the health of people in society,
especially their spiritual health, is essential. Spiritual
health provides a harmonious and integrated connection
between internal forces. It defines the feeling of a close
relationship with oneself, God, society, and the environment
with the characteristics of stability in life, peace,
and harmony. Spiritual health determines the integrity of
an individual [17].
The use of spirituality can effectively promote social
support, adaptation, and compliance in matters related
to health [18]. The concept of perceived social support
means a person’s cognitive assessment of the environment
and relationships with others. Kubzanski, Berkman, and
Seaman argued that by creating reciprocal commitments,
social support makes a situation in which one feels loved,
cared for, respected, and valued. Throughout life, people
need intimate and supportive environments to master appropriate
coping methods to ensure their mental and spiritual
health. Social support enables growth and self-fulfillment
by creating a sense of security in the individual [19].
Social support is the strongest and most potent factor for
successful and easy coping in times of stress [20]. Social
support is related to health and has positive consequences
on people’s health, especially spiritual health [21]. This
study found that social support, perceived as a critical
variable, has an essential role in promoting spiritual
health. In other words, the importance of spiritual health
in various fields has led to its role in promoting social support
and the formation of social groups.
Research has also shown that stress and overall selfefficacy
are associated with school burnout and engagement.
They defined self-efficacy and social support as
internal and external variables related to burnout of technical
and vocational students. They also found that students’
academic burnout has a significant and negative
effect on academic achievement [22].
Evidence and conducted research inside and outside
of Iran indicate that school burnout is a serious issue
in learners’ academic years. Meanwhile, students, as
the educated strata of society and those responsible for
the society’s future, are more affected by the adverse effects
of school burnout, such as impairment in mental,
psychological, and physical wellbeing. School burnout
is a crucial factor in understanding students’ academic
behaviors and performance. It affects students’ relationships
with their place of study and their desire to continue
their education [23]. Therefore, the student’s perception
of social support by classmates and teachers is very
effective in reducing their school burnout, and paying attention
to issues related to students as future builders of
society is of particular importance. Improving students’
educational status, especially the factors affecting the
Table 5. Results of 1-sample t test examining the spiritual health, social support, and school burnout
Variables Number Mean±SD Test Value t df Sig.
Spiritual health 234 36.95±10.11 70 34.93 233 0.001
Social support 234 22.46±74.10 36 14.55 233 0.001
School burnout 234 85.27±17.13 45 -82.50 233 0.001
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September 2021. Volume 8. Number 3
reduction of school burnout and increasing their spiritual
health, is one of the main goals of current education
systems. One of the effective factors in reducing school
burnout and increasing spiritual health is the social support
perceived by students.
In this regard, it is suggested that educational workshops
and packages be held to increase spiritual health
and social support and reduce burnout in students, teachers,
and parents. One of the study limitations was the
statistical population confined to sixth-grade female students
in Rudbar City, Iran. So care should be taken in
generalizing the findings. Also, considering that in the
present study, only one tool (questionnaire) was used
to collect the desired information, while other methods
such as interview, observation may yield different
results. It is also suggested that similar studies be conducted
in larger and different communities to generalize
the results further.
Conclusion
The primary purpose of this study was to investigate
the effect of spiritual health on school burnout with the
mediating role of social support in sixth-grade female
students in Rudbar City. The results showed a direct
and significant relationship between spiritual health and
school burnout, between spiritual health with students’
social support, and between school burnout and students’
social support. There was an indirect and significant relationship
between spiritual health and school burnout
with the mediating role of students’ social support. Also,
the levels of spiritual health and perceived social support
of students were high, but the degree of school burnout
of students was low.
Ethical Considerations
Compliance with ethical guidelines
There were no ethical considerations to be considered
in this research.
Funding
The paper was extracted from the MA thesis of the first
author.
Authors' contributions
Both authors equally contributed to preparing this article.
Conflict of interest
The authors declared no conflict of interest.
Acknowledgments
We would like to take Dr Hossein Janabadi, our esteemed
professor, who guided us in the dissertation
from which the article was extracted. We also appreciate
all who helped us in conducting this study.
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