ARTICLE INFO

Article Type

Original Research

Authors

Sharifi Aref   A. (1)
Tavousi   M. (2)
Amin Shokravi   F. (*1)






(1) Department of Health Education & Promotion, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
(2) Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran

Correspondence

Article History

Received:  November  5, 2019
Accepted:  April 26, 2020
ePublished:  September 20, 2020

BRIEF TEXT


Despite the life stress, the adolescence period for a person is accompanied by more pressure because of comprehensive physical, mental, and identity crises, as far as adolescence period Known as physiological stress period [1-3].

…[4-11]. Anxiety is one of the most common psychiatric disorders in adolescence. It has been shown that 5-%10 of adolescents are facing one of the diagnostic criteria for anxiety disorder [14]. …[12, 13]. Researches in children and adolescents also indicate the prevalence of moderate to severe depression in 2.3-5.9% of children and adolescents [15]. …[16-20]. Debnam et al. [21] and Hassan et al. [17] considered spirituality as an effective protective factor against stress. Wang et al. noted the association between higher levels of religiosity/spirituality in adolescents with better mental health through reviewing 20 articles [22] so that Kim & Squiol in a study introduce spirituality as a way to promote mental health in adolescents [23]. In this regard, Ajdarifard et al. [24] and Boroumandzadeh & Sani [25] emphasized spirituality-oriented trainings as an effective factor in increasing general health, mental health and reducing anxiety and depression [26-29].

The aim of this study was to evaluate the effect of spirituality-based training intervention on reducing stress, anxiety, and depression in health ambassadors.

This study is a quasi-experimental study.

This study was carried out on the female health ambassadors of the Middle Schools in Tehran in 2019.

Sampling was conducted by the multi-stage cluster method; first, one area (area 4) was selected among the different areas of the city by the simple random sampling method, and 2 schools were selected among the secondary schools of that area, as the experimental and control schools. The health ambassadors of these schools entered the study voluntarily according to the inclusion criteria (including not participating in spirituality-related training courses at the same time, non-use of psychological or other psychotherapy services) and exclusion criteria (includes absence in training sessions more than 3 sessions, having history of mental disorders, death of first-degree relatives, the divorce of parents and having history of severe stress in the past 6 months). The sample size of the study for two dependent groups were 27.73±12.99, and 17.40±11.96, respectively, according to the results of Boroumandzadeh & Sani [25], the mean and standard deviation of anxiety before and after the educational intervention, and the formula for determining the sample size [25]. Based on the above information, the sample size was estimated to be about 16 people, taking into account the probability of statistical drop, 21 people in each group were determined.

The research instruments were the stress, anxiety, and depression questionnaire (DASS 21) [30-33] and the Parsian and Daning Spirituality Questionnaire [34]. Since DASS 21 is the abbreviated form of DASS-42 (main), the scores obtained in each subscale should be doubled and classified according to the below table [33] (Table 1).After collecting information in the pre-test stage, the educational intervention was performed by the researcher in the experimental group in 5 sessions of 60-90 minutes, once a week, and the health ambassadors of the control group did not receive any educational intervention.In this intervention, educational packages prepared based on the pre-test results and using relevant texts (educational books and packages prepared by the Ministry of Education, Ministry of Health and articles related to spirituality and spiritual health) were used to teach spiritual issues to health ambassadors in high school (Table 2).45 days after the end of the training sessions, the level of stress, anxiety, and depression in the experimental and control groups were measured again. In the experimental group, there was 3 statistical drop in the sample size and finally, the information of 39 subjects (n=18 in the experimental group and n=21 in the control group) was examined. Data were analyzed by SPSS 20 software using Chi-square, independent T, paired T-tests, and multivariate analysis of covariance.

There was no significant difference between experimental and control groups in terms of demographic variables and qualitative and quantitative contexts (p>0.05; Table 3).Students in both groups were at normal and mid-levels in terms of stress, anxiety, and depression variables, respectively, before the intervention. There was no significant difference between the two groups in terms of mean scores of stress, anxiety, and depression before the intervention (p>0.05). There was no significant difference between the mean scores of the two groups after the intervention (p>0.05; Table 4).There was no significant difference between the two groups in terms of mean scores of spirituality and its components before the intervention (p>0.05). The experimental and control groups had significant differences only in the component of spiritual activities, after the intervention (p=0.038). Also, the mean score of the spiritual needs component of the experimental group after the intervention showed a significant increase compared to before the intervention (p=0.043), but other components and the overall score of spirituality did not change significantly (p>0.05). The mean scores of spirituality and its components in the control group did not change significantly after the intervention compared to before the intervention (p>0.05; Table 5).In examining the effect of pre-test scores on post-test scores, the pre-test score of spirituality had an effect on post-test scores of anxiety and depression (p<0.05; Table 6).There was a direct and significant and inverse correlation between the variables of stress (r=-0.445; p=0.05) and depression (r=-0.406; p=0.05). There was a direct and significant correlation between depression and anxiety (r=0.591; p=0.01).

According to the results of this study, there was no significant difference between the mean score of spirituality in students' lives in the experimental group before and after the intervention. The results were different from the results of studies of Khalifi et al. [35], Ajdriifard et al. [24], Boroumandzadeh & Sani [25] as well as Shahbazi et al. [34] and Movahedi et al. [36]. In addition, there was no significant difference between the mean score of self-awareness, the importance of spirituality in life and students' spiritual activities in relation to spirituality before and after training in both experimental and control groups. The obtained results are different from the results of the research of Shahbazi et al. [34] in relation to patients with type 1 diabetes. However, the comparison between the mean score of students 'spiritual needs before and after training in the experimental and control groups showed the effect of educational intervention on students' spiritual needs, which is in accordance with the study of Shahbazi et al. [34]. …[37]. In this study, although only the increase in the mean score of spiritual needs was statistically significant, the other components of spirituality increased in the experimental group. In addition, the rate of increase in the mean scores of other spirituality components in the experimental group was higher than the control group, which its reason can be the provided training. This increase in the mean scores is in accordance with the results of the studies of Boroumandzadeh & Sani [25], Movahedi et al. [36], Khalifi et al. [35] and Shahbazi et al. [34, 37]. The mean scores of stress, anxiety, and depression of students in the experimental and control groups were not significantly different before and after training and these results are different from the results of the researches of Movahedi et al. [36], Ajdriifard et al. [24], Boroumandzadeh & Sani [25], Abdolkhalek [38] and Desrozieers & Miller [39]. On the other hand, in this study, it was found that there was a negative correlation between spirituality with depression. The results of this study were confirmed by the studies of Mahmoudvand [40], Hasan et al. [17], Firoozi et al. [41], Wang et al. [22], Kim & Squiol [23], Abdolkhalek [38] and Deserozyers & Miller [39].

The use of multidimensional interventions with a focus on the individual, environmental, and social factors are suggested for future research. It is also suggested that similar studies be performed in the group of health ambassadors by removing the barriers and problems in this study in both genders.

Compulsory implementation of the intervention program on determined time by the relevant ministry can affect the study process especially in the case of projects that take into account the psychological aspects of individuals. The effect of simultaneous training intervention with the students' exam season on the results of the exam cannot be denied. Separating stress, anxiety, and depression reduction due to training from stress, anxiety, and depression reduction due to the end of the exam season made the test impossible, which can be considered as a confounding variable.

Despite the lack of significant effect of spirituality-based training intervention on increasing spirituality and reducing stress, anxiety, and depression in student health ambassadors, but since the changes occurred in the group of healthy adolescents (physically and mentally), it is significant. Also, due to the correlation between spirituality and stress and depression, increasing and promoting spirituality can reduce the amount of stress and depression and prevent the occurrence of these problems and their complications in the future of this age group (adolescents).

We thank the spiritual support of the Tarbiat Modares University and the ones who helped us in carrying out this research in the Health Department of the Ministry of Education.

There is no conflict of interest.

This research has been approved by the National Ethics Committee in Biomedical Research of Tarbiat Modares University with the ethics code IR.MODARES.REC.1397.175.

This article is retrieved from the master's dissertation of Azam Sharifi Aref, a graduate of Tarbiat Modares University.

TABLES and CHARTS

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