Health, Spirituality and Medical Ethics

Introduction
Childhood and adolescence are vital periods for mental health. Children and adolescents develop cognitive and social-emotional skills during this period, shaping their mental health and preparing them to play adult roles in society [1]. Psychologists believe that many children and teenagers face problematic social and educational situations at school, at home, and in society, which can lead to problems in their future lives. Sudden and extensive changes in all aspects of teenagers’ lives create a sensitive stage that this period may cause many social, psychological, and communication problems for teenagers [2]. Adolescence and the post-COVID-19 period have brought new challenges for students. Long-term quarantines, school closures, and switching to virtual education have had significant adverse effects on students’ mental health. In the meantime, tenacity and social vitality are two key factors in students’ mental health and academic performance, and they have become particularly crucial [3].
Psychological hardiness is described as a general style of functioning accompanied by a strong sense of commitment (the ability to see the world meaningfully), control (the belief that one can influence events), and challenge (attention to new experiences in life as new opportunities for personal growth). Hardy individuals consider life to be purposeful and view it as an opportunity for growth and empowerment. Recent studies have shown that people with high psychological hardiness can better tolerate levels of stress and pressure in life [4].
In other words, psychological hardiness is a sign of mental health in people. People with high psychological hardiness feel committed to their actions and behavior, they believe that life events are controllable and predictable, and finally consider a change in life and the need to adapt to it as a chance and struggle to grow in life rather than a threat to security [5]. Numerous studies have shown that hardiness is effective in improving mental and physical health and directly relates to social vitality. Specifically, individuals with higher hardiness are likely to experience higher levels of social vitality due to better abilities to cope with stress and challenges [6]. For example, a study in 2022 showed a positive relationship between psychological hardiness and social vitality in college students. This study emphasized that increasing hardiness can help improve social vitality and reduce anxiety. The relationship between hardiness and social vitality is such that people with higher hardiness have a more remarkable to dealing with daily challenges and stresses, which increases their social vitality [7].
Social vitality is one of the crucial indicators of mental health in society and one of the basic concepts and components of people’s lives, especially students, which includes three essential components: Emotional, cognitive, and social. The emotional component makes a person always happy and cheerful, the social component causes the expansion of social relationships, and the cognitive component causes happy people to interpret and follow the daily events of their lives positively [8]. Students’ social vitality, as a key concept in positive psychology, includes positive emotions, high energy, and effective and positive social interactions. This feature can directly impact students’ mental health, academic performance, and overall well-being. A study conducted by Collie showed that the satisfaction of basic psychological needs, such as autonomy, competence, and communication, plays a crucial role in the social vitality of students. This study states that supporting these needs in the educational environment can help increase students’ motivation and social vitality [9].
In this regard, measures should be taken to increase students’ psychological hardiness and social vitality as the future builders of society in the post-COVID-19 era. Most students have problems and deficiencies in social skills. Therefore, students should be taught social skills in an organized manner [10]. Due to the spread of COVID-19 and the extensive social and psychological effects, the world’s education system faced significant challenges in the post-COVID-19 era. School closures, limited educational opportunities, and loss of social communication as major factors gradually affected the students’ psyche and their family members. In such a situation, the need for innovative solutions to support mental health and increase students’ psychological hardiness and social vitality is felt more than ever. Spiritual intelligence can play a crucial role in this field as a powerful resource for coping with stress and challenges. Spiritual intelligence refers to a person’s ability to understand and process spiritual and psychological experiences that are usually formed through life experiences. This type of intelligence helps people solve daily problems and achieve their goals using spiritual resources. As a dimension of human intelligence, spiritual intelligence refers to abilities beyond intellectual intelligence (IQ) and emotional intelligence (EQ) and includes qualities, such as wisdom, compassion, integrity, joy, love, creativity, and peace. In other words, spiritual intelligence helps a person build a meaningful and purposeful life using spiritual principles and values ​​and effectively face challenges and problems [11]. Various studies have been conducted on the effectiveness of spiritual intelligence in various aspects of life. Fidelis et al. conducted a comprehensive and systematic review of different perspectives on spiritual intelligence. By analyzing 64 articles and reviews, this study identified four main perspectives: Western, Eastern, Islamic, and indigenous. Each of these views emphasizes its own cultural and social foundations and explains spiritual intelligence differently. This article concludes that spiritual intelligence is a multidimensional concept that extensively affects various aspects of individual and social life [12]. For example, in a study on spiritual intelligence and psychological well-being, spiritual intelligence significantly and positively predicted psychological well-being [13].
Several recent studies have examined the relationship between spiritual intelligence and resilience, all indicating a positive correlation between these two concepts. For example, a study in 2023 showed that spiritual intelligence has a positive relationship with resilience among university students, and people with higher spiritual intelligence are more able to cope with stressful situations and life challenges [14]. Another systematic review in 2024 also emphasized that spiritual intelligence helps regulate emotions better, which helps to strengthen resilience in academic and life contexts [15].
In another research investigating the relationship between spiritual intelligence, communication self-efficacy, and job satisfaction in nurses, the results showed that spiritual intelligence is positively related to nurses’ self-efficacy and job satisfaction and can help improve their efficiency and job satisfaction [16]. A systematic review and meta-analysis published in 2023 examined the relationship between spiritual intelligence, emotional intelligence, and students’ academic achievement. This study included 27 articles conducted on 5781 students. The results showed that higher levels of spiritual intelligence are related to better academic performance and this relationship was stronger among university students than high school students. This study suggested that integrating spiritual intelligence education into educational settings can improve students’ academic success and well-being [17].
Recent research shows that spiritual intelligence significantly affects students’ social vitality. Spiritual intelligence is defined as the ability to understand and use spiritual concepts in daily life and is associated with an increased sense of connection, self-awareness, and empathy. These characteristics help students establish stronger social relationships and be more resistant to life challenges [18].
For example, a study in 2022 showed that spiritual intelligence and social happiness are positively related to each other, and people with higher levels of spiritual intelligence tend to experience more social happiness [19]. In another research, the relationship between spiritual intelligence and psychological well-being was investigated. The results showed that spiritual intelligence plays a crucial role in improving the quality of life and reducing stress, which can lead to increased social vitality. These results also showed that strengthening spiritual intelligence can be used as an effective strategy to improve the social and psychological vitality of students [20]. Also, the results of another systematic review and meta-analysis showed that spiritual intelligence is directly related to academic success and satisfaction with life. This study showed that students with higher spiritual intelligence are generally more satisfied with their lives and social interactions, which can lead to increased social vitality. This result emphasizes that developing spiritual intelligence in students can be used effectively to improve their social vitality and general well-being [17].
Students are valuable hope and capital of every society and also play a role in the progress and promotion of the country. Psychological hardiness and social vitality are key factors in students’ academic success and mental health. In the post-COVID-19 era, students faced many psychological and academic challenges. Increasing these two factors can have a vital role in helping them overcome problems and maintain academic performance. On the other hand, spiritual intelligence can help people deal with stress and challenges by enhancing spirituality, hope, and purposefulness in life. Therefore, given the sensitivity and importance of social hardiness and vitality in students as the future builders of society, as well as their impact on psychological growth and the need for intervention in this area, and considering the lack of coherent and practical research in this field, this study was conducted to investigate the effectiveness of spiritual intelligence training on students’ psychological hardiness and social vitality in the post-COVID-19 era among male secondary school students. The hypothesis being investigated is that spiritual intelligence training affects students’ psychological hardiness and social vitality in the post-COVID-19 era. The results of this study can help improve students’ psychological hardiness and social vitality after COVID-19 through spiritual intelligence training.

Methods
This quasi-experimental study employed a pre-test and post-test design with a one-month follow-up and a control group. The statistical population included all students studying in the first secondary school in Qom City, Iran, in 2023-2024. After obtaining permission for educational research in one of the schools, seventh-grade students were selected using a convenience sampling method. Following the selection of 30 students interested in participating, a drawing method or random numbers table was used to allocate them to the experimental and control groups. Each participant was first assigned a number from 1 to 30. Then, using the random numbers table, 15 participants were assigned to the experimental group and 15 to the control group. Odd-numbered participants were assigned to the experimental group, while even-numbered participants were assigned to the control group, ensuring that the allocation was completely random and free of bias. It should be noted that the minimum sample size for such studies in the statistical literature, is 15 people [21]. The inclusion criteria included the ability to attend meetings, conscious and voluntary from both the student and their parents to participate, no physical or psychological problems, and no participation in other medical and educational programs. The exclusion criteria included lack of motivation and interest, not attending more than two sessions, and participating in other training and medical programs. Before the intervention, both the experimental and control groups completed questionnaires on psychological hardiness and social vitality. Then, based on the Bowel spiritual intelligence training package (2004) and similar research in spiritual intelligence education, the experiment group participated in the program for ten 80-minute sessions, held twice a week [22]. After the educational period concluded and during the one-month follow-up period, both groups again completed the psychological hardiness and social vitality questionnaires. Data were analyzed using SPSS software, version 22 and repeated measures analysis of variance (ANOVA).
Research tools
Lang and goulet’s psychological hardiness scale (2003) [15]: Lang and Goulet’s psychological hardiness scale is a self-report scale that includes 45 questions scored on a five-point Likert scale (disagree to agree), which is based on a conceptual definition of psychological hardiness. It was developed by Yang & Geng to assess this variable in specific and stressful conditions [17]. In Iran, this scale was also assessed by Roshan and Shakeri (2010) as part of a structural validity study using three methods: Factor analysis, correlation with other tests (construct validity), and discriminant validity. Statistical methods, such as calculating the internal consistency coefficient (Cronbach’s α), split-half method, and test re-test method, were used [24] to measure the reliability of the scale. The reliability of this questionnaire in the present study was 0.86.
Social vitality scale: Zare and Aminpour designed this 37-question questionnaire, which measures five subscales of life satisfaction, appearance, social interactions, personal efficacy, and helping others. The minimum score on this test is 37, and the maximum is 74. A high score indicates greater happiness and vitality. In Zare and Aminpour’s study, content validity was confirmed by professors from the Faculty of Educational Sciences and Psychology at Allameh Tabatabaei University, and the overall reliability was 0.77 using Cronbach’s α [25]. The overall reliability in the present study was 0.71 using Cronbach’s α.
Table 1 presents a summary of the content and purpose of each intervention session based on the Bowel spiritual intelligence training package (2004). This training package has also been used in other studies and has demonstrated good reliability and validity [22].
Results
The mean age in the experimental group was 12.63±0.783 years, and in the control group, it was 12.84±0.798 years. No significant difference was observed in age between the two groups, and the groups were homogeneous (Table 2).
Repeated measures ANOVA was used to examine the significance of the difference between the scores of psychological hardiness and social vitality in the experimental and control groups.
The results of repeated measures ANOVA among groups studied for psychological hardiness and social vitality variables showed that the effect between the subjects (groups) was significant. This indicates that a difference is observed in at least one group for one of the psychological hardiness and social vitality variables. The intra- group effect (time) was also significant for research variables, which means that from the pre-test phase to the follow-up stage, at least one of the average variables was associated with change (Table 3).
The results of Table 4 show that the ANOVA result was significant for the intra-group (time) and inter-group factors. These results indicate that considering the group effect, the time effect alone was significant. Also, the interaction between group and time was significant, and Bonferroni’s post hoc test was used to compare the groups.
The results of Table 5 show that the scores for psychological hardiness and social vitality in the experimental group during the post-test stage are higher than those in the control group. In other words, the increase in psychological hardiness and social vitality in the experimental group is significantly influenced by this intervention. Also, the results showed that the experimental group’s psychological hardiness and social vitality remained stable in the follow-up phase.


Discussion
The current research was conducted to assess the effect of spiritual intelligence training on student’s psychological hardiness and social vitality in the post-COVID-19 era. The first result showed that spiritual intelligence training significantly affected the psychological hardiness of students; this means that this education could increase the psychological hardiness of students. This result is consistent with that of Stolaraski et al. [26], Dadashi-Tonkaboni et al. [27], Yang and Jenj [17],  Ebrahimi [19], and Yang & Geng [17]. To explain this result, we can examine the psychological and operational mechanisms that these training programs provide. Spiritual intelligence helps students gain a deeper understanding of themselves. This self-awareness enables them to recognize their strengths and weaknesses and face challenges more effectively. In the post-COVID-19 era, students with more self-awareness can better cope with changes and uncertainties, demonstrating increased hardiness [26]. Additionally, one of the key principles of spiritual intelligence is the ability to manage stress and anxiety Using meditation and spiritual thinking techniques, students can reduce their stress levels and face problems more calmly. These skills help increase hardiness, especially in the post-COVID-19 era when stress and anxiety are high [27]. Also, spiritual intelligence training helps students discover a deeper meaning and purpose in their lives. In the post-COVID-19 era, having a spiritual goal can serve as a driving force and motivate students to be more resilient in the face of difficulties [28]. Also, spiritual intelligence training improves interpersonal relationships and creates stronger support networks. These relationships can serve as a source of social support that helps students be more resilient when facing challenges and crises [29]. Furthermore, spiritual intelligence, by increasing psychological resilience, helps students cope with life’s problems and obstacles better. Resilience means returning to the original state after experiencing stressful events. By strengthening this ability, spiritual intelligence training increases students’ hardiness in the post-COVID-19 era [30].
The present study also showed that spiritual intelligence training has a significant effect on the social vitality of students. Accordingly, this training can increase the social vitality of students. The present research’s results are consistent with those of Raheja et al., Huang and Zhang, and Hamilton and Gross [31-34]. Spiritual intelligence helps people better understand and manage their emotions and spiritual experiences. This capability can help students better cope with the stress and psychological pressure experiencing in the post-COVID-19 era. Understanding and regulating emotions helps students reduce negative emotions and enhance positive emotions, which directly leads to increased social vitality [31]. Also, spiritual intelligence can help improve students’ psychological capital by strengthening positive emotions and developing characteristics, such as hope, resilience, and optimism. This psychological capital allows students to better withstand the challenges and stresses of the post-COVID-19 era and to benefit from social support, thereby enhancing their personal well-being and making them more socially active [32]. In addition, spiritual intelligence training can improve the social and emotional skills of students. These skills include communicating effectively, regulating emotions, and having positive social interactions, all of which play a crucial role in improving social vitality. By developing these skills, students can better adapt to the changes and challenges of the post-COVID-19 era and build stronger social relationships [33]. Also, spiritual intelligence training can help create supportive learning environments. These environments give students a sense of security and support, which is critical to their mental health and social vitality. Creating such environments can reduce stress and increase student satisfaction [34]. Spiritual intelligence training by strengthening students’ psychological and social abilities can positively affect their social vitality in the post-COVID-19 era and help them better face its new challenges.
Conclusion
The results of this study showed that spiritual intelligence training positively affects students’ psychological hardiness and social vitality. Therefore, incorporating spiritual intelligence training programs into educational systems is an effective solution. In addition, the post-COVID-19 era has highlighted the importance of spiritual intelligence. The COVID-19 pandemic has brought unprecedented stress and challenges to students by creating fundamental changes in daily life and educational environments. During this period, spiritual intelligence has emerged as a crucial resource for addressing these challenges and maintaining students’ mental health. Given the positive effects of spiritual intelligence training, schools, and educational institutions should pay more attention to the importance of this training and design and implement programs that help develop this type of intelligence in students. These programs can include activities, like meditation, awareness exercises, and training courses on spiritual and ethical concepts. However, it should be noted that spiritual intelligence is only one of the factors affecting psychological hardiness and social vitality, and other factors, such as social support, economic status, and family circumstances also play a crucial role. Therefore, a multifaceted and comprehensive approach considering all these factors is necessary to achieve desirable results. Finally, it is suggested that future research examines the long-term effects of spiritual intelligence training on psychological hardiness and social vitality, as well as the interactions between spiritual intelligence and other factors affecting students’ psychological and academic well-being. Such research can provide deeper insights and help develop more effective strategies to improve students’ well-being. Finally, it should be noted that this study, like other studies, also faced limitations, the most crucial of which was the short duration of the training workshop, which was held immediately after the end of the classroom. On the other hand, this study was conducted only among male students in the first-secondary school in Qom City; thus, caution should be exercised when generalizing its results to other educational levels, female students, and students in other regions of the country.
Ethical Considerations
Compliance with ethical guidelines
Ethical standards, such as obtaining informed consent and confidentiality were followed in this research. While emphasizing the importance of completing all the questions, participants were free to withdraw from the study based on their conditions and the duration required to complete the questionnaires. After the completion of the research, the contents of the sessions taught to the experimental group were also provided to the control group.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.
Conflict of interest
The author declared no conflict of interest.
Acknowledgments
The author appreciates all the students and education officials of District One of Qom City.