Health, Spirituality and Medical Ethics

Introduction

Social well-being refers to the quality of an individual’s relationships with their social environment and those around them. It includes elements, such as a sense of belonging to society, establishing positive relationships with others, understanding and respecting individual differences, and participating in social activities [1]. Social well-being enables individuals to establish healthy and meaningful relationships with others and experience a sense of belonging to society and social networks [2-3]. Individuals with higher levels of social well-being generally experience greater emotional and psychological security through active participation in interpersonal relationships and social networks [4]. By providing a sense of purpose, belonging, and connection with a higher power, spirituality helps individuals cope better with life’s challenges and feel more satisfied and at peace. These factors ultimately lead to increased social well-being and a deeper meaning in life [5].

Social well-being is significantly associated with other aspects of students’ mental health, such as depression, anxiety, and stress [6-7]. Students with more social support are more resilient and less prone to loneliness, depression, and anxiety [8, 9]. Therefore, paying attention to students’ social well-being and its related spiritual factors is particularly important and necessary.

Self-compassion is one of the factors and variables related to social well-being. Self-compassion means a loving and understanding approach to oneself in the face of failures, mistakes, or difficulties, and is also considered one of the variables related to spiritual health [10]. People with this characteristic are more tolerant of themselves in difficult situations and manage negative emotions with kindness and acceptance instead of blaming themselves [11]. By relying on spiritual power and belief in God and supernatural power, these individuals consider themselves more valuable and loved than if they were to wallow their negative emotions during difficulties [12]. Self-compassion is particularly crucial for students, as they struggle with various academic, social, and psychological challenges. Students’ ability to cope with these challenges and manage the resulting psychological stress is directly related to their level of self-compassion [13]. Research has shown that students with higher self-compassion experience less stress and anxiety. When faced with academic or social setbacks, they focus on learning and personal growth rather than feeling hopeless [14, 15].

Another variable related to improving social well-being is optimism. Optimism, a positive and hopeful attitude towards the future and one’s ability to face challenges and difficulties, is a fundamental characteristic that can help improve individuals’ quality of life and mental health [16]. Optimistic individuals trust their abilities to solve problems and find effective solutions when faced with obstacles and problems, rather than focusing on negative aspects and despair [17]. In addition, spirituality, by strengthening faith, hope, and trust in the existence of a superior order in the world, makes individuals look at the future with a more positive view and feel less hopeless in the face of problems. This spiritual attitude provides the basis for increasing optimism and belief in the possibility of positive events in life [18]. Optimism is key in managing academic and psychological pressures [19]. Optimistic students tend to persevere in the face of academic stress rather than feeling helpless and are more motivated to achieve their goals [20]. Optimism is also directly linked to reduced anxiety and depression, as optimists are less likely to experience negative thoughts and despair due to their positive outlook on the future and ability to cope with challenges [21]. Despite the importance of social well-being in students’ mental health, previous research has focused mainly on individual factors such as social support and resilience. The role of cognitive-emotional and spiritual characteristics, such as optimism and self-compassion, in predicting social well-being has received less attention. The existing research gap suggests that examining these two variables simultaneously can lead to a deeper understanding of the mechanisms influencing students’ social interactions. This study can help expand the psychological foundations related to social well-being, and its findings can effectively develop counseling and educational programs to improve students’ mental health. Therefore, this study aimed to investigate the role of optimism and self-compassion in predicting students’ social well-being.

Methods

This study was descriptive-correlational. The statistical population of the present study was students studying at the Islamic Azad University, Birjand Branch, in the second half of the academic year 1403-1404. From the aforementioned statistical population, 350 students were selected using a multi-stage random sampling method (cluster) and responded to research questionnaires including the standard social well-being questionnaire, the standard self-compassion questionnaire, and the optimism questionnaire. In this study’s multi-stage random sampling method, the university faculties were first considered clusters, and then a number of students were randomly selected from each faculty. This method allowed the researcher to collect a representative sample from different subgroups of the statistical population while maintaining randomness. First, the Islamic Azad University, Birjand Branch, faculties were considered clusters. With the help of a research expert from each faculty number, who identified and recruited students, a random number of students answered the research questionnaires. The inclusion criteria included being enrolled in the Islamic Azad University, willingness to participate in the study, self-declared confirmation of not having specific mental illnesses, such as schizophrenia, anxiety disorders, and bipolar disorders, and self-declared confirmation of not having specific physical illnesses, such as hemophilia, cancer, and pulmonary and cardiovascular diseases. The exclusion criteria included the questionnaire being corrupted (the answer being illegible and more than one answer being marked) and a lack of interest in participating in the study. It is also crucial to mention that the researcher tried to be present in front of the students of the sample group during all stages of completing the questionnaire to explain possible ambiguities. After completing all the questionnaires, their numbering process was performed in SPSS software, version 27. In the next step, the research data were analyzed and examined at two descriptive levels (frequency, percentage, Mean±SD) and inferential (Pearson correlation coefficient and multiple regression analysis). The research tools are introduced below.

Standard social welfare questionnaire: This 33-item questionnaire was developed by Keyes in 1998 based on their theoretical foundations of the social well-being construct [22]. Items (6, 8, 14, 19, 23, 27, and 31) measure the social acceptance subscale, items (2, 9, 10, 12, 16, and 21) the social cohesion subscale, items (1, 11, 13, 20, 22, 29, and 33) the social solidarity subscale, items (3, 4, 24, 26, 28, and 32) the social participation subscale, and items (5, 7, 15, 17, 18, 25, and 30) the social flourishing subscale on a five-point Likert scale [23]. An individual’s minimum and maximum scores in the questionnaire ranged from 33 to 165. In 1998, Keyes conducted a study with a sample size of 2887 people in the United States using factor analysis to confirm the five social well-being factors in the questionnaire. In 1998, he reported the reliability of the questionnaire using Cronbach’s α for social cohesion as 0.64, social flourishing as 0.64, social solidarity as 0.73, social participation as 0.66, and social acceptance as 0.41 [24]. Safarinia et al. reported the reliability of the questionnaire using Cronbach’s α for the entire scale as 0.76 and for each of the subscales as 0.77 for social integration, 0.74 for social participation, 0.74 for social acceptance, 0.73 for social self-actualization, and 0.75 for social solidarity [25]. In the present study, Cronbach’s α coefficient for this questionnaire was estimated to be 0.87.

Self-compassion questionnaire: The self-compassion questionnaire is a 26-item scale developed by Neff in 2003 to measure self-compassion in six subscales: kindness toward oneself (five items), judgment about oneself (five items), shared human feelings (four items), isolation (four items), mindfulness (four items), and grandiosity (four items). This questionnaire is scored on a 5-point Likert scale from almost never (1) to almost always (5). The range of scores on this questionnaire is between 26 and 130, with higher scores indicating greater self-compassion. The correlation coefficient of the six factors of this scale and self-compassion (total scale) has been confirmed at the 0.001 level [26]. The results of Neff’s research have shown high reliability and validity [26]. The internal consistency of the scale was obtained through the Cronbach’s α coefficient, calculated for the entire scale at 0.92 [27]. In the study by Asadi and Oskoui Shomali, the instrument’s validity in Iran was confirmed by the Cronbach’s α coefficient of the aforementioned questionnaire equal to 0.78, indicating its desirable validity [27]. In the present study, the Cronbach’s α coefficient of this questionnaire was estimated to be 0.88.

Optimism questionnaire: This scale was developed in 10 statements by Scheier and Carver in 1994, and responses to these statements were made on a five-point Likert scale from completely disagree (0) to completely agree (4). Some statements were scored in reverse. Higher scores indicate a positive orientation towards life. The validity of this test has been confirmed in several studies [28]. Hinz et al. reported a Cronbach’s α of 0.57 to 0.75 and test-retest coefficients of 0.43 to 0.69 in a study on eight different population samples, which was confirmed by factor analysis [29]. Khodaei et al. also reported a negative relationship between pessimism (r=0.33) and life satisfaction in Iran [30]. A positive relationship was found between optimism and life satisfaction (r=0.33). They obtained internal consistency coefficients of 0.77 and 0.88. Cronbach’s α for this test was 0.85 in the study by Tanhaye Reshvanloo et al. [31]. In the present study, the Cronbach’s α coefficient of this questionnaire was estimated to be 0.84, confirming its desirable reliability.

Results

Table 1 presents the study’s demographic findings. Based on the data presented, 37% of the participants were between 18 and 25 years of age, 30% between 25 and 30, and 33% were 30 and older. Also, 55.28% of the participants were male and 44.72% were female, indicating a relatively balanced gender distribution in the sample. Regarding the field of study, the highest share was for medical students (32.75%), and the lowest was for engineering and technical students (10.25%). Table 2 presents the descriptive findings and correlation coefficients between self-compassion and optimism and students’ social well-being.

Based on the results obtained from Table 2, all the calculated correlation coefficients between self-compassion and optimism with students’ social well-being were positive and significant at the alpha level of 0.01. The positivity of the obtained coefficients indicated a direct relationship between self-compassion and optimism and students’ social well-being (P<0.01).

A multiple regression test was used to predict students’ social well-being through optimism. The Durbin-Watson statistic was used to examine the independence of the residuals. Given that its value (2.221) is in the range of 1.5 to 2.5, it can be said that the assumption of independence of the residuals was satisfied. To examine the existence of multiple collinearity between the predictor variables, tolerance indices and variance inflation factor (VIF) were used, and according to the results obtained, no deviation from the multiple collinearity assumption was observed. Tables 3 and 4 present the results of the multiple regression analysis for predicting social well-being through optimism and self-compassion.

In Table 3, the F value obtained for examining the regression model was 48.52, which was significant at an alpha level of <0.01, indicating that optimism can explain changes related to social well-being and indicating the appropriateness of the presented regression model. The R-square value was 0.458, which showed that optimism can explain 45.8% of the variance in the social well-being of students at Islamic Azad University, Birjand Branch. The standardized regression coefficient (Beta) value for optimism was (P<0.01, β=0.405). Therefore, it was concluded that optimism positively and significantly predicted students’ social well-being. A multiple regression test was used to predict students’ social well-being through self-compassion. The Durbin-Watson statistic was used to examine the independence of the residuals. Given that its value (2.103) is in the range of 1.5 to 2.5, it can be said that the assumption of independence of the residuals was satisfied. To examine the existence of multiple collinearity between the predictor variables, tolerance indices and VIF were used, which, according to the results obtained, showed no deviation from the assumption of multiple collinearity.

In Table 4, the F value obtained for examining the regression model was 18.50, which was significant at an alpha level of <0.01, indicating that self-compassion could explain the changes related to students’ social well-being, indicating the appropriateness of the presented regression model. The R-squared value was 0.502, which showed that self-compassion can explain 50.2% of the variance in social well-being of students at Islamic Azad University, Birjand Branch. The standardized regression coefficient (Beta) for self-compassion was (P<0.01, β=0.413). Therefore, it was concluded that self-compassion positively and significantly predicted students’ social well-being.

Discussion

The present study was conducted to investigate the role of optimism and self-compassion in predicting students’ social well-being. According to the findings, optimism and self-compassion play a significant role in predicting students’ social well-being, explaining 45.8% (R2=0.458) and 50.2% (R2=0.502) of the variance, respectively.

The study’s first finding showed that optimism plays a positive and significant role in predicting students’ social well-being. This finding is consistent with the results of Siddique et al. [17], Ciria-Suarez et al. [18], and Börü et al. [21]. In explaining this finding, it should be said that one of the reasons for this positive relationship can be attributed to the way optimistic individuals process information and interpret social events. Optimists tend to view negative events as temporary and controllable, and instead of blaming themselves or society, they look for solutions to improve the situation [19]. A related study by Bohman et al. showed that this mindset helps them to receive more social support and have more constructive social interactions in difficult situations. In contrast, pessimists may attribute social failures to their own inadequacies and, therefore, withdraw from social interactions, ultimately leading to a decrease in their social well-being [20]. Related studies have shown that optimism can increase self-confidence in social relationships, because optimistic people are more likely to establish positive and constructive relationships and are less afraid of rejection [17]. Another factor that highlights the role of optimism in students’ social well-being is its relationship with social resilience and flexibility. Studies have shown that students with a positive outlook on the future can better manage these issues and maintain their relationships when faced with academic failures, economic difficulties, or social conflicts [21]. A parallel study by Bohman et al. suggests that these students not only have more social support but also become a source of support for others. Studies have shown that optimistic individuals participate more in group and social activities because they believe their actions can positively impact themselves and society [20]. Therefore, increasing optimism among students can lead to a more positive campus environment, greater participation in social programs, and strengthened student solidarity. The second finding of the study showed that self-compassion also plays a positive and significant role in predicting students’ social well-being. This means that increasing self-compassion is associated with improving and growing social well-being in students. This finding is also consistent with the results of research by Neff [26], Han et al. [11], Lv et al. [12], and Cha et al. [13], which show that the more self-compassion a person has, the higher their level of social interactions, feelings of acceptance from others, and social support. Self-compassion reduces stress, increases psychological flexibility, and improves interpersonal skills, ultimately leading to increased social well-being [10]. In the study by Lv et al. one of the most crucial reasons why self-compassion enhances social well-being is the reduction of social anxiety and an increase in the sense of security in interpersonal relationships. Students who are kinder to themselves experience less shyness, self-criticism, and fear of being judged during social interactions. These students communicate more easily in the university environment, are more active in social activities, and adopt a more flexible approach when faced with interpersonal conflicts [12]. In contrast, Kroshus et al. showed that highly self-critical people tend to avoid social situations because they fear that others will disapprove of them. This increases their isolation and reduces their social well-being. Therefore, teaching self-compassion can help reduce social anxiety and increase students’ social participation [31]. In addition, self-compassion increases satisfaction with interpersonal relationships and creates positive interactions in the university community [10]. A similar study by Cha et al. showed that students with a more compassionate attitude towards themselves also adopt a more empathetic approach in their interpersonal relationships and are less likely to engage in unhealthy competition or harmful relationships. When faced with conflicts, these students try to solve the problem with understanding and empathy instead of emotional and defensive reactions. Such an attitude makes them more popular in social groups and creates deeper and lasting relationships [13]. Therefore, strengthening self-compassion can help improve the quality of social relationships, increase social support, and thus promote students’ social well-being. Universities can create a suitable environment for developing self-compassion in students by implementing educational programs and communication skills workshops, which will ultimately lead to increased mental and social health [11].

Conclusion

The findings of this study show that optimism and self-compassion play significant roles in predicting students’ social well-being. Optimistic and self-compassionate individuals experience more positive social relationships and have a greater sense of belonging to society. These results highlight the importance of fostering a positive outlook on the future, self-compassionate, and spiritual behaviors in promoting students’ social well-being.

Limitations and suggestions

The most critical limitations of the present study include the use of a self-report instrument (questionnaire), the use of convenience sampling, limiting the research population to students of the Islamic Azad University, Birjand Branch, the subjective nature of the variables examined in this study (optimism, self-compassion, and social well-being), and the existence of response bias, memory error, or the tendency to provide socially desirable answers, the failure to examine the role and effect of variables such as economic status, lifestyle, level of family and cultural support, personality traits, and other social factors that can affect social well-being, and the cross-sectional nature of the study, failing to examine the causal relationship between the variables. In future studies, more diverse methods, such as in-depth interviews or objective assessments, should be used to reduce bias caused by self-report instruments. Also, conducting longitudinal studies can help better understand the causal relationships between variables. In practical terms, universities and student counseling centers can help strengthen students’ mental health by providing self-compassion skills workshops and teaching positive attitudes. It is also recommended that educational policymakers, given the importance of healthy social interactions, provide platforms to increase the sense of belonging to the university environment and promote social support among students.

Ethical Considerations

Compliance with ethical guidelines

The present study was approved by the Research Ethics Committee of Islamic Azad University, Birjand Branch, Iran (Code: IR.IAU.BIRJAND.REC.1403.035). In all stages of the research, including writing, data collection, and compliance with the principles of confidentiality of the sample group and freedom to not participate in the research, data analysis, and accurate data reporting, the principles of ethics in medical research according to the 2008 Declaration of Helsinki were observed.

Funding

This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Authors' contributions

Study design, writing, and editing: Esmaeil Sadeghi; Supervisor and statistical analysis: Mojtaba Ahmadi.

Conflict of interest

The authors declared no conflicts of interest.

Acknowledgments

The authors sincerely thank all students who participated in this study for their time, trust, and openness in sharing their experiences.