Original Article

The Relationship of Spiritual Health with Quality of Life,Mental Health, and Burnout: The Mediating Role of Emotional Regulation


Objective: The World Health Organization's definition of health now stands open to severe criticism due to changes in today's world and the accompanying mental void; in addition to physical, psychological, and social aspects, spiritual health and its interaction with the other aspects has been studied in scientific literature and recent research. The present study was conducted to investigate the mediating role of emotional regulation in the relationship between spiritual health with quality of life, psychological health, and burnout.
Method: In this study, 231 staff from Baqiyatallah University of Medical Sciences completed Spiritual Well-Being Scale (SWBS), Difficulties in Emotion Regulation Scale (DERS), World Health Organization Quality of Life-BREF (WHOQOL-BREF), General Health Questionnaire-28 (GHQ-28), and Maslach Burnout Inventory (MBI). The gathered data were analyzed using Pearson correlation, Hierarchical Regression analysis, and Sobel’s test.
Results: All variables were correlated with one another (p<0.001). The hierarchical regression analysis and Sobel’s test indicated that the emotional regulation have a relative mediating role in the relationship between spiritual health and quality of life (ß=0.53, Z=4.05, p<0.001) and a complete mediating role in the relationship between spiritual health with mental health (ß=0.68, Z=5.62, p<0.001) and burnout (ß=0.70, Z=6.12, p<0.001).
Conclusion: There is a complex and non-linear relationship between spiritual health and the areas of quality of life, mental health and burnout. This relationship is potentially influenced by emotional regulation.

Macleod J, Davey Smith G, Heslop P, Metcalfe Ch, Carroll D, Hart C. Psychological stress and cardiovascular disease: empirical demonstration of bias in a prospective observational study of Scottish men. BMJ 2002; 324: 1247-1251.

Dhar N, Chaturvedi SK, Nandan D. Spiritual health scale 2011: defining and measuring 4 dimension of health. Indian J Community Med 2011; 36: 275-282.

Damari B. [Health Sprituality (Persian)]. Tehran: Medical and society publication; 2009.

Allahbakhshian M, Jaffrpour M, Parvizy S, Haghani H. A Survey on relationship between spiritual wellbeing and quality of life in multiple sclerosis patients. ZahJ Res Med Sci 2010; 12: 29-33.

Burkhardt A, Nathaniel M, Alvita K. Ethic in chronic pain. In: Burkhardt A NM, Alvita K, editor. Ethic and issue in contemporary nursing 1ed. London: Mosby; 1998.

Finkelstein FO, West W, Gobin J, Finkelstein SH, Wuerth D. Spirituality, quality of life and the dialysis patient. Nephrol Dial Transplant 2007; 22: 2432-2434.

Büssing A, Ostermann T, Matthiessen PF. Adaptive coping and spirituality as a resource in cancer patients. Breast care 2007; 2: 195-202.

Fisch MJ, Titzer ML, Kristeller JL, Shen J, Loehrer PJ, Jung SH, et al. Assessment of quality of life in outpatients with advanced cancer: the accuracy of clinician estimations and the relevance

of spiritual well-being-a Hoosier Oncology Group Study. J Clin Oncol. 2003; 21(14):2754-9.

Dalmida SG, Holstad MM, Diiorio C, Laderman G. Spiritual Well-Being and Health-Related Quality of Life Among African-American Women with HIV/AIDS. Appl Res Qual Life 2011; 6: 139-157.

Basavaraj KH, Navya MA, Rashmi R. Quality of life in HIV/AIDS. Indian J Sex Dis 2010; 31: 75-80.

Sajjadian E, Nadi MA. [Understanding the relationship between mental health and hope to future between employees in an industrial factory (Persian)]. Biennial conference Industrial/ Organizational Psychology, Islamic Azad University, Isfahan (Khorasgan) Branch, Iran: 2010.

Akbarizadeh F, Bagheri F, Hatami HR, Hajivandi A. [Relationship between nurses. Spiritual intelligence with hardiness and general health (Persian)]. Behbood 2012; 15: 466-472.

Mazidi M, Ostovar S. Effects of religion and type of religious internalization on the mental health of Iranian adolescents. Percept Mot Skills 2006;103: 301-306

Krishnakumar S, Neck CP. "The “What”, “Why” and “How” of Spirituality in the Workplace". J Manag Psychol 2002; 17: 153-164.

Kinjerski V, Skrypnek Berna J. Creating Organizational Conditions that Foster Employee Spirit at Work". Leadership Org Dev J 2006; 27: 280-295.

Milliman J, Czaplewski AJ, Ferguson J. Workplace Spirituality and Employee Work Attitudes, an Exploratory Empirical Assessment. J Organ Change Manag 2003; 16: 426-447.

Claude J, Zamor G. Workplace Spirituality and Organizational Performance. Public Adm Rev 2003; 63: 355-364.

Jang SJ, Johnson BR. Explaining religious effect on distress among African Americans. J Sci Study Relig 2004; 43: 239-260.

Doolittle BR, Farrell M. The association between spirituality and depression in an urban clinic. Prim Care Companion J Clin Psychiatry 2004; 6: 114-118.

Hills J, Paice JA, Cameron JR, Shot S. Spirituality and distress in palliative care consultation. J Palliat Med 2005; 8: 782-788.

Sorajjakool S, Aja V, Chilson B, Ramirez J, Earll A. Disconnection, depression and spirituality: A study of the role of spirituality and meaning in the lives of individuals with severe depression. Pastoral Psychol 2008; 56: 521-532.

Koenig HG, Cohen HJ, Blazer DG, Pieper C, Meador KG, Shelp F, et al. Religious coping and depression among elderly, hospitalized medically ill men. Am J Psychiatry 1992; 149: 1693-1700.

Koenig HG, McCullough M, Larson D. Handbook of religion and health. New York: Oxford University Press; 2000.

Hummer R, Rogers R, Nam C, Ellison C. Religious involvement and US adult mortality. Demography 1999; 36: 273-285.

Desrosiers A, Miller l. Relational spirituality and depression in adolescent girls. J Clin Psychol 2007; 63: 1021-1037.

Bahrami H, Alizade H, Ghobaribonab B, Karami A. [Efficacy Spirituality of group education on reducing depression (Persian)]. J Consult Res Dev 2006; 3: 49-72.

Aliani Z, Mahin H. [Relationship between adherences to pray with the anxiety of students of Tabriz University (Persian)]. Paper presented at the Second Seminar mental health. Tehran; Tarbiat Modares University, Iran: 2004.

Gross JJ, Thompson RA. Emotion regulation: Conceptual foundations. In J. J. Gross (Ed.), Handbook of emotion regulation. New York: Guilford; 2007.

Zammuner VL, Gallinari G, Galli C. Emotion Regulation in Bank Employees Regulation, Antecedents and Mediators, and Impact on Well-Being. Front Psychol Behav Sci 2013; 2: 125-138.

Gross JJ, John OP. Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. J Pers Soc Psychol 2003; 85: 348-362.

Hu T, Zhang D, Wang J, Mistry R, Ran G, Wang X. Relation between emotion regulation and mental health: Ameta-analysis review 1, 2. Psychol Rep 2014; 114: 341-362.

Thompson RA. Emotion regulation: A theme in search of definition. In N. A. Fox (Ed.), the Development of Emotion Regulation Biological and Behavioral Considerations. The University Of Chicago Press; 1994.

Gross JJ. Emotion regulation: Past, present, future. Cogn Emot 1999; 13: 551-573.

Van Leeuwen R, Cusveller B. Nursing competencies for spiritual care. J Adv Nurs 2004; 48: 234-246.

Elkins M, Cavendish R. Developing a plan for pediatric spiritual care. Holist Nurs Pract 2004; 18: 179-184.

Raghibi M, Gharahchaghi M. [An investigation of the relation between emotional and spiritual intelligence among well adjusted and discordant couples (Persian)]. Women and Society 2013; 4: 123-140.

Hajian A, Sheikhuleslami M, Homaei M, Rahimi F, Aminoroaia M. [Relationship between spiritual and emotional intelligence (Persian)]. Behavioral Sciences Research 2012; 10: 500-506.

Mesri M, Rahmati F, Moradi M. [Development and assessment of index of health spiritual and predicted factor in military staff. Center of teb and din (Persian)]. Baqiyatallah University of Medical Sciences 2014.

Meyers L, Gamst G, Guarino AJ. Applied multivariate research. London: SAGE Publications; 2005.

Paloutzian RF, Ellison CW. Loneliness: A sourcebook of current theory, research and therapy. New York: Wiley; 1982.

Dehshiri G, Sohrabi F, Jafari E, Najafi M. [Investigation of psychometric properties of spiritual well-being scale among students (Persian)]. Psychol Study 2008; 4: 35-45.

Gratz KL, Roemer L. Multidimensional assessment of emotion regulation a dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess 2004; 26: 41–54.

Asgari P, Pasha G, Aminian M. [The relationship emotional regulation, life events and body image with eating disorder in women (Persian)]. J Andisheh Raf 2009; 4: 65-78.

Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med 1979; 9: 139-145.

Yaghubi N, Nasr M, Shahmohammadi D. [Epidemiology of Mental Disorders in Urban and Rural Areas of Sowmaesara-Gillan (Persian)]. IJPCP 1995; 1: 55-60.

Nurbala A, Bagheri A, Mohammad K. [The validation of general health questionnaire-28 as a psychiatric screening tool (Persian)]. Hakim 2009; 11: 47-53.

Malakooti K, Mirabzadeh A, Fathollahi P , Salavati M , Kahali Sh , Afkham Ebrahimi A, et al. [Validity, reliability and factor analysis of general health questionnaire-28 (GHQ-28) in Iranian elderly (Persian)]. Iranian Journal of Ageing 2006; 1: 11-21.

Maslach C, Jackson SE. Manual of the Maslach Burnout Inventory, 2eds. Palo Alto: Consulting Psychologist Press Inc; 1993.

Hosseinaei A, Nouferesti A. [Study on rate and factors of job burnout of Foundation of martyrs and veterans affair personnel and present solutions (Persian)]. Foundation of Martyrs and Veterans Affair Researches; 2009.

Ramezaninezhad R, Khabiri M, Asadi H, Hemmatinezhad MA. [Study on job stressors among athletic coaches of Iran (Persian)]. Movement 2000; 6: 59-72.

World Health Organization. The World Health Organization Quality of Life (WHOQOL)-BREF. Geneva: WHO; 2004.

Nejat S, Montazeri A, Holakouie Naieni K, Mohammad K, Majdzadeh S.R. [The World Health Organization quality of Life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version (Persian)]. Journal of School of Public Health and Institute of Public Health Research 2007; 4: 1-12.

Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986; 51: 1173-1182.

Jamali N, SHakerinia I, Jalili Nikoo S, Ghasemi Jobaneh R. Role of Spiritual Health and Emotional Regulation in Mental Health of Nulliparous Women. Health Spiritual Med Ethics 2017; 4: 32-37.

Hosseindokht A, Fathi-Ashtiani A, Taghizadeh ME. [Relation between spiritual intelligence and spiritual wellbeing with quality of life and marital satisfaction (Persian)]. Ravanshenasi Va Din 2013; 6: 57-74.

Barberis N, Cernaro V, Costa S , Montalto G , Lucisano S, Larcan R, Buemi M. [The relationship between coping, emotion regulation, and quality of life of patients on dialysis (Persian)]. The International Journal of Psychiatry in Medicine 2017; 52: 111-123.

Bahrami B, Bahrami A, Mashhadi A, Kare shki H. [The role of cognitive emotion regulation strategies in the quality of life of cancer patients (Persian)]. Med J Mashhad Univ Med Sci. 2015; 58: 96-105.

Jalilvand MA. [The relationship between mental health and adherence to religious restrictions (prayer) in university students (Persian)]. Paper presented at the Second Seminar mental health. Tehran, Tarbiat Modares University, Iran: 2004.

DaalemanTP, Kaufman JS. Spirituality and depressive symptoms in primary care out patients. South Med J. 2006; 99: 1340-1344.

Waltington CG, Murphy CM. The roles of religion and spirituality among African–American survivors of domes violence. J Clin Psychol 2006; 62: 837-857.

Zimmer Z, Jagger C, Chiu C, Ofstedal MB, Rojo F, Saito Y. Spirituality, religiosity, aging and health in global perspective: A review. SSM -Population Health 2016; 2: 371-81.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: Author; 2013.

Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Ed. New York: Wolter Kluwer; 2014.

Kring AM, Sloan DM. Emotion regulation in psychopathology: A transdiagnostic approach to etiology and treatment. New York: Guilford; 2010.

Mennin DS, Fresco DM. Emotion regulation as an integrative framework for understanding and treating psychopathology. In AM. Kring, DM Sloan, Emotion regulation and psychopathology: A transdiagnostic approach to etiology and treatment. New York: Guilford Press; 2010.

Teasdale JD, Barnard PJ. Affect, cognition, and change: Re-modeling depressive thought. Hove, UK: Erlbaum; 1993.

Ashkanasy NM, Ashton-James CE. Emotion in organizations: A neglected topic in psychology, but with a bright future. International review of industrial and organizational psychology 2005; 20: 221-268.

Grandy A. Emotion regulation in the workplace: A new way to conceptualize emotional labor. J Occup Health Psychol 2000; 5: 95-110.

Zhou G, Yan X, Tang X, Gan, Y. The Influence of Emotion Regulation on Job Burnout among Teachers. Adv Psychol 2012; 2: 93-99.

Zahra Nikmanesh Z, Shirazi M, Farazinezhad F. Examining the Predictive Role of Emotional Self-Regulation in Quality of Life and Perception of Suffering among Patients with Breast Cancer. Middle East Journal of Cancer 2017; 8: 93-101.

Mustafa, Michael; Santos, Angeli and Chern, Gwi Terk. Emotion regulation and burnout among Malaysian HR managers: The moderating role of big five personality traits [online]. International Journal of Employment Studies 2014; 22: 79-108.

Moraes AGD, Wilson ME, Gajic O, Benzo R. The Impact of emotional intelligence on Burnout, Job CSI, Self-Compassion, and communication skills in critical care trainees. American Journal of Respiratory and Critical Care Medicine 2015; 191: 123-134.

IssueVol 13 No 1 (2018) QRcode
SectionOriginal Article(s)
Burnout Emotional Regulation Mental Health Quality of Life Spiritual Health

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Akbari M, Hossaini SM. The Relationship of Spiritual Health with Quality of Life,Mental Health, and Burnout: The Mediating Role of Emotional Regulation. Iran J Psychiatry. 2018;13(1):22-31.