Health, Spirituality and Medical Ethics

Introduction
Emotional adjustment is vital to people’s quality of life as a crucial component of mental health and personal growth [1]. This concept refers to a person’s ability to regulate emotions, cope with life’s stresses and pressures, and establish healthy and effective relationships with others [2]. Students are more exposed to emotional fluctuations due to being in the transitional stage between adolescence and adulthood, facing academic pressures, family and community expectations, and social and economic challenges [3]. Emotional adjustment during this period can prevent psychological problems and improve academic performance [4]. Students who can manage their emotions and face stress and problems healthily are usually more successful in their studies and more satisfied with their lives [5, 6]. Several studies have shown that strengthening emotional adjustment skills through educational and counseling programs can help improve the students’ quality of life and reduce problems, such as anxiety, depression, and academic failure [7, 8]. Therefore, paying attention to the promotion of emotional adjustment and factors related to its growth in students seems necessary not only for academic success but also for their mental and social health [9]. Recently, researchers in psychology have considered spirituality and lifestyles based on religion and spirituality, which are aligned with the improvement in mental health and adjustment of students [10].
Spiritual vitality is one of the consequences of incorporating spirituality and religiosity into life [11]. The importance of spirituality and spiritual growth in humans has increasingly attracted the attention of psychologists and mental health professionals [12]. Spiritual vitality encompasses peace, compassion, hope, piety, forgiveness, inner freshness, clarity, and a heartfelt belief in the Creator of the Universe [13]. It originates from the ups and downs of life, is sensitive to the joys and sorrows of others, and represents an internal harmony that resolves internal differences [14]. People with high spiritual vitality achieve a kind of self-control that prevents the effectiveness of external conditions. As a result, they are less affected by inappropriate conditions and improve their fear of failure and sense of psychological security [15]. Research has shown that spiritual vitality fosters hope, increases the meaning of life, improves mental health, and reduces mental disorders such as depression and anxiety [16]. Studies have also confirmed the relationship between spiritual vitality, academic success, and mental health of students [17], as well as its role in reducing fear and despair and improving the mental and emotional well-being of medical students [18].
On the other hand, an Islamic lifestyle is vital for improving mental health [19]. A lifestyle is the personal and unique strategy and set of opinions established during childhood; it is a relatively fixed way in which a person pursues their goals. In other words, it is a means to achieve those goals [20]. According to another definition, a lifestyle is a coherent set of behaviors and actions exhibited by a group of people during a specific period, which can also be regarded as a unique way of life [21]. To find the best type of lifestyle, a model that considers all a person’s cognitive and behavioral components in the best way and does not neglect any material and spiritual aspects of a person is needed [22]. The Islamic lifestyle, due to the comprehensiveness of the religion of Islam, also includes social components and consists of ten indicators: Social, devotional, beliefs, ethics, financial, family, health, thinking and science, defense-security, and chronology [23]. Research has confirmed the relationship between an Islamic lifestyle and the academic vitality and performance of students [22], as well as the religious growth of students [24] and their academic self-efficacy and resilience [25].
Considering the importance and necessity of examining the students’ emotional adjustment as one of the factors affecting their mental health, along with the existing research gap in the field, no study has investigated the role of Islamic lifestyle and spiritual vitality in students’ emotional adjustment. The present study was conducted to investigate the role of Islamic lifestyle and spiritual vitality in predicting the emotional adjustment of Farhangian University students.
Methods
The current study was descriptive-correlational. The statistical population included 2 128 male and female students from the Farhangian University of South Khorasan Province, Iran (Campus of Shahid Bahonar University of Birjand, Campus of Imam Sajjad University of Birjand, and Campus of Bent Al-Hoda Sadr Ferdous University) during the 2023-2024 academic year. Based on Karjesi and Morgan’s table (1971), 319 students were selected from among eligible individuals using the stratified sampling method (girls and boys). The questionnaires were distributed and collected in dormitories with the assistance of a dormitory supervisor and student leaders. The researchers were also present during the completion of the questionnaires to clarify possible ambiguities.
The inclusion criteria included informed consent to participate in the study, an age range of 18 to 23 years, a willingness to participate in the research, no diseases or mental disorders, and complete physical health based on the health record available in the student administration (which was consciously reviewed through self-declaration by students and then examined by the researchers with the informed consent and approval of the student). The exclusion criteria included incomplete responses, distortion of the questionnaire, and lack of cooperation in the research process.
Statistical analysis, including the relationships between variables, was performed using Mean±SD, Pearson correlation, and multiple regression analysis using SPSS software, version 26.
The research tools included Farahbakhsh’s emotional adjustment questionnaire (2011), Chirian and Afroz’s spiritual vitality questionnaire (2016) and Kaviani’s Islamic lifestyle questionnaire (2009) [26-29].
Emotional adjustment questionnaire
In 2011, Farahbakhsh designed the emotional adjustment questionnaire to measure emotional adjustment. This questionnaire contains 13 closed-ended items based on a five-point Likert scale from 1) very little to 5) Very much. Farahbakhsh confirmed the validity of this questionnaire, with an average Lawshe coefficient of 0.71 to explain the content validity of the entire test, while the coefficients for the subscales ranged from 0.58 to 0.82. In Farahbakhsh’s research, the content and face validity of this tool were confirmed by the approval of 15 expert professors in psychology (educational, clinical, and general). In addition, the correlation of the test’s total score with the general health questionnaire (GHQ) was -0.58. For other subscales, the correlation was between -0.27 and -0.43, indicating its validity. The internal reliability of the whole scale was determined to be 0.94, while for the sub-tests, it ranged from 0.73 to 0.81 [26]. In the present study, Cronbach’s α coefficient for the Emotional Adjustment Questionnaire was 0.83, indicating its desirable reliability.
Islamic lifestyle questionnaire
In 2008, Kaviani Arani developed the Islamic lifestyle questionnaire [27]. This questionnaire consists of 75 items that students should answer on a 4-point scale, ranging from very little to very much, based on their life conditions. The following ten indicators constitute the subscales of this test: Social index (11 items), beliefs (6 items), worship (6 items), ethics (11 items), finance (12 items), family (8 items), health (7 items), thinking and science (5 items), defense security (4 items) and chronology (5 items). Respondents answered each item according to their current life situation on a four-point scale, with each item assigned a coefficient between 1 and 4 based on its importance. The overall reliability coefficient of this test is 0.71. The results of the factor analysis also showed a suitable factor structure, with a reliability of 0.64, which is consistent with the test of religious orientation. The reliability for the subscales is as follows: Social index 0.41; beliefs 0.46; worship 0.30; ethics 0.64; finance 0.32; family 0.40; health 0.42; thinking and science 0.51; defense security 0.30; and chronology 0.30 [27]. In Moazzami’s research [28], the reliability value with Cronbach’s α for the entire instrument was calculated to be 0.83, indicating its appropriate reliability. In the present study, the Cronbach’s α coefficient of this questionnaire was obtained to determine its reliability, which indicated its desirable reliability.
Spiritual vitality questionnaire
In 2016, Chirian and Afrooz designed the spiritual vitality questionnaire to examine the level of spiritual vitality. It consists of 60 items and three dimensions (beliefs, feelings, and behavior) [29]. It is scored based on a four-point Likert scale from 1) Strongly disagree to 4) Strongly agree. They examined content validity through experts in this field [29]. Additionally, they estimated the internal consistency using Cronbach’s α coefficient, which was found to be 0.99 after implementing the questionnaire on 3,000 secondary school students in Tehran Province, Iran. To determine validity, the correlation of the total score with all the questions in the questionnaire was used. The correlation coefficient obtained ranged from 0.141 to 0.92, which was significant at the 1% error level. The content validity of this questionnaire has been confirmed by several experts [30]. Also, in Kazemi et al.’s research, the reliability of the subscales for beliefs, feelings, and behavior was found to be 0.86 and 0.89, respectively, using Cronbach’s α method [31]. In the present study, Cronbach’s α coefficient for the questionnaire was determined to be 0.87, indicating its desirable reliability.
Results
Table 1 presents demographic information of the samples, including age, sex and field of study.
Based on the results presented in Table 2, all the correlation coefficients calculated between Islamic lifestyle and spiritual vitality with emotional adjustment were positive and significant at 0.01. The positivity of the obtained coefficients shows a direct relationship between Islamic lifestyle, spiritual vitality and emotional adjustment (P<0.01).
A multiple regression analysis predicted students’ emotional adjustment to the Islamic lifestyle. The Durbin-Watson statistic was used to check the independence of the residuals. Considering that its value (1.893) was between 1.5 and 2.5, the assumption of independence of the residuals was upheld. Tolerance indices and the variance inflation factor (VIF) were used to check the multicollinearity between the predictor variables and according to the results, no deviation was observed from the multicollinearity assumption.
In Table 3, the F value obtained to examine the regression model was 10.664, which was significant at an α level of less than 0.01. This finding indicates that an Islamic lifestyle can effectively explain the changes related to emotional adjustment and demonstrates the appropriateness of the regression model. An R2 value of 0.370 was obtained, which showed that Islamic lifestyle explained 37% of the variance in emotional adjustment. Therefore, it was concluded that among the components of the Islamic lifestyle, the components of beliefs and health positively and significantly predicted the emotional adjustment of students. Overall, the results of multiple regression analysis indicated that emotional adjustment can be positively and significantly predicted through the total score of the Islamic lifestyle.
A multiple regression analysis predicted students’ emotional adjustment through spiritual vitality. The Durbin-Watson statistic was used to check the independence of the residuals. Given that its value (1.715) falls between 1.5 and 2.5, the assumption of independence of the residuals was upheld. Tolerance indices and VIF were used to check for multicollinearity between the predictor variables, and according to the obtained results, no deviation was observed from the multicollinearity assumption.
In Table 4, the F value obtained to examine the regression model was 35.146, which was significant at an α level of less than 0.01. This indicates that spiritual vitality can explain the changes related to emotional adjustment and indicates the appropriateness of the presented regression model. The R2 value was equal to 0.458, indicating that the components of spiritual vitality explained 45.8% of the variance in emotional adjustment. Therefore, it was concluded that the emotional and behavioral components of spiritual vitality positively and significantly predicted students’ emotional adjustment. The results of the multiple regression analysis indicated that the total score of spiritual vitality could positively and significantly predict emotional adjustment.
Discussion
The present study was conducted to investigate the role of Islamic lifestyle and spiritual vitality in predicting the emotional adjustment of Farhangian University students. The results showed that spiritual vitality and Islamic lifestyle positively and significantly predicted students’ emotional adjustment.
The first research result showed a positive and significant relationship between Islamic lifestyle and students’ emotional adjustment. This means that increasing scores for the Islamic lifestyle are associated with increasing scores for emotional adjustment in students. This result is consistent with those of Safara and Khanbabaee [19], Ghamari [22], Nazoktabar et al. [23]. In explaining this result, it should be said that the more a person adheres to Islamic principles and values, the better is his/her ability to manage and regulate emotions and emotional relationships. This result can be attributed to the positive effects of Islamic teachings on various psychological aspects of people. By emphasizing values, such as inner peace, patience, life satisfaction, and strengthening positive relationships with others, the Islamic lifestyle contextualizes the promotion of emotional adjustment. Religious beliefs, such as trust in God, divine wisdom, and satisfaction with destiny, help people feel calmer and more stable in facing challenges and emotional problems [19]. According to Solikhah’s research [32], these beliefs enable people to achieve a deeper meaning in life and better manage negative emotions instead of focusing on the stresses and worries of everyday life. Regular worship, such as prayer, fasting, and other religious rituals, not only strengthens a person’s relationship with God but also has a positive psychological effect on mental and emotional peace. Sharifi et al. [24] also showed that daily prayers create a sense of order and inner peace, which can help improve emotional adjustment. In addition, the recommendations of Islam about maintaining physical health through healthy eating, exercise and moderation in life matters improve the physical condition and, as a result, strengthen positive feelings and emotional adjustment [22]. Jones [33] showed that an Islamic lifestyle increases security and belonging and reduces anxiety and stress by strengthening healthy social relationships and spirituality. Also, observing moral and spiritual principles in an Islamic lifestyle improves self-awareness and emotion regulation. Finally, connecting religious values ​​and strengthening faith can lead to better emotional adjustment and a reduction in psychological problems in students. This suggests that the happier and more spiritual individuals are, the better their ability to manage their emotions and regulate their emotional relationships improves
The results showed a positive and significant relationship between spiritual vitality and students’ emotional adjustment. This means that an increase in spiritual vitality scores was associated with an increase in students’ emotional adjustment scores. This result is consistent with that of Malekiha and Olyanasab [11], Wilson [12], Mohammadi et al. [13] and Abrishamkar et al. [15]. This suggests that the happier and more spiritual people are, the better their ability to manage emotions and regulate their emotional relationships. Spiritual vitality is a state, in which a person with a deep connection and a transcendent force, finds meaning and a higher purpose in life, and feels satisfaction and inner peace with his/her existence. This state helps a person achieve mental and emotional balance and better face life’s challenges [11]. This spiritual state makes people more resilient and balanced against problems and emotional tensions. Students who have achieved spiritual vitality usually experience greater inner peace and are able to view issues from a positive and spiritual perspective rather than through emotional reactions [12]. Ahghar et al. [34] concluded that a connection with spirituality enables individuals to approach their problems from a spiritual perspective when faced with emotional challenges and failures, allowing them to find suitable solutions instead of succumbing to despair or stress. This type of deep spiritual perspective helps individuals better control negative emotions, such as anxiety, depression, or anger, because behind these emotions lies a meaningful sense of trust in spiritual support. Spiritual vitality helps improve emotional adjustment by creating a sense of hope, inner satisfaction, and acceptance of life events. Those who have achieved this type of vitality often have better psychological balance because they are mentally and emotionally connected to a source of energy and peace that transcends daily problems [17].
Bennet’s research [35] showed that spiritual vitality helps students cope better with emotional challenges by creating a sense of hope, meaning, and purpose. This type of vitality strengthens inner peace and reduces anxiety and depression through communication with God, prayer, and meditation. Spiritual vitality increases self-awareness and acceptance of negative emotions, which helps improve emotion regulation and emotional adjustment. Finally, spirituality helps students be stronger against psychological pressure and manage their emotions constructively. Finally, this result shows that paying attention to the spiritual aspects of life and strengthening spiritual vitality can be key factors in improving the emotional adjustment of students because this vitality increases mental peace and reduces emotional tensions.
Conclusion
The results showed that the Islamic lifestyle and spiritual vitality could predict the emotional adjustment of Farhangian University students. Therefore, university planners and mental health offices should consider these components.
Limitations
This study, like any other research, has limitations. One of the most significant limitations is that it was conducted in South Khorasan Province. Therefore, the generalization of the results should be approached with caution, and it is recommended that future studies examine and compare a larger population of students on a national scale. Another limitation of this study is that the application of the Islamic lifestyle, spiritual vitality, and students’ emotional adjustment (challenges and solutions) should be qualitatively investigated to obtain deeper insights and interpretations.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Birjand University of Medical Sciences (Code: IR.BUMS.REC.1402.240) and all ethical principles were considered in all research stages.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.
Authors' contributions
All authors contributed equally to the conception and design of the study, data collection and analysis, interception of the results, and manuscript drafting. Each author approved the submission of the final version of the manuscript.
Conflict of interest
The authors declared no conflict of interest.
Acknowledgments
The authors would like to thank everyone who assisted the researchers in this study, especially the students.