1. Background
Religion serves as a profound foundation for shaping human existence and fulfilling essential needs. The absence of genuine religious belief may lead to psychological distress, despair, and a sense of meaninglessness (1, 2). Throughout history, religion has been deeply embedded in human societies, influencing values, behavior, and emotional well-being. Religious individuals often experience greater resilience, deriving comfort from faith, social and spiritual support, and a sense of belonging, which help them better manage life’s challenges (3). As a comprehensive system of values, norms, and rituals, religion provides individuals and societies with a structured model for living and fosters creativity and adaptability in facing limitations (4). Many scholars view religion as an innate human inclination that satisfies fundamental emotional and existential needs, explaining its persistence across time and cultures (5).
Research consistently indicates that religious people tend to report better mental health, including lower anxiety and depression levels, compared with their less religious counterparts (6). Medical students, however, represent a population particularly vulnerable to stress, anxiety, and depression due to academic pressure, long hours, and constant exposure to illness and suffering (7). In this context, religiosity has been identified as a potential coping mechanism. For example, studies among students in East Malaysia found that higher religiosity was associated with lower depression, anxiety, and stress (8), while Brazilian research reported links between intrinsic religiosity, spiritual peace, and greater happiness and optimism (7). Nonetheless, the relationship between religiosity and mental health is complex. Positive religious coping can act as a protective factor, whereas negative religious coping is linked to higher distress levels (9). Additionally, some studies have reported no significant association between religiosity and psychological disorders among medical students, underscoring the need for further investigation across different cultural and demographic contexts (10).
2. Objectives
Students are the main pillars of society and the future builders of the country, and having peace, health, and efficiency in various biological, physical, psychological, and social areas is essential for their success in life. Given the esteemed position of religion and spirituality and the importance of the quality of life (QoL) of university students, who are the nation’s cultural and intellectual capital and play a crucial role in construction, religiosity, and social advancement, Also given that no research was conducted in this field focusing on medical students, the present research was conducted to determine the correlation between religious attitudes and QoL among students at Abadan University of Medical Sciences in 2024.
3. Methods
3.1. Study Design
The present study is a descriptive-analytical that was conducted in Abadan University of Medical Sciences in 2023 - 2024. The inclusion criteria included studying at Abadan University of Medical Sciences, studying in the second semester or above, and expressing a willingness to participate in the study. The exclusion criteria were incomplete questionnaires and guest students.
The study population in this study comprised all students studying at Abadan University of Medical Sciences in 2023 - 2024. Using the formula and the MedCalc software, the sample size was calculated to be 385 with a 5% margin of error and a standard deviation of 0.1. To account for a 20% dropout rate, the final sample size was determined to be 462.
3.2. Participants
All students studying in 11 disciplines in Abadan University of Medical Sciences were considered as the research population. Using proportional stratified random sampling, 462 out of 1498 students from 11 different fields of study, including medicine (n = 177), nursing (n = 92), medical laboratory sciences (n = 31), operating room (n = 26), anesthesia (n = 30), public health (n = 17), environmental health (n = 21), occupational health (n = 17), health information technology (n = 18), librarianship (n = 13), and emergency medicine (n = 20), were included in the study.
3.3. Scales
Data were collected using three instruments: A demographic questionnaire, the Khodayarifard’s Religious Attitude Scale (11), and the World Health Organization Quality of Life - Brief Version (WHOQOL-BREF) (12). The demographic questionnaire included items on age, gender, field and semester of study, academic level, parents’ education, marital status, type of residence, satisfaction with the chosen field, and overall grade point average (GPA).
The Religious Attitude Scale, developed by Khodayarifard through a study of 4,000 university students, consists of 40 items across four subscales: Religious beliefs (12 items), religious emotions (12 items), religious behaviors (12 items), and social pretense (4 items) (11).
Responses are rated on a six-point Likert scale ranging from 0 (“never”) to 5 (“always”), with total scores ranging from 0 to 200. Higher scores indicate stronger religious attitudes. The scale has demonstrated strong psychometric properties, with reported reliability coefficients of 0.96 and 0.94 in two separate studies, a test-retest reliability of 0.91, and a split-half reliability of 0.82 based on the Spearman-Brown method.
The WHOQOL-BREF, a 26-item instrument developed by the World Health Organization, assesses overall QoL across four domains: Physical health (7 items), psychological health (6 items), social relationships (3 items), and environment (8 items), along with two general items on overall QoL and health. Each item is rated on a 5-point Likert scale, where higher scores reflect better QoL. The Persian version of WHOQOL-BREF has been validated in Iran by Nejat et al., demonstrating satisfactory test - retest reliability across all subscales (0.75 - 0.84) (12).
3.4. Data Collection
To collect data, questionnaires were administered in person to the research samples. After obtaining informed consent, participants were provided with detailed instructions on how to complete the questionnaires. Students were also assured that the responses would be analyzed confidentially and in general. Data collection was carried out between November 2023 and December 2024.
3.5. Data Analysis
After data collection, an analysis of demographic characteristics was conducted using descriptive statistics, including measures of central tendency and dispersion, as well as frequency and percentage. Independent t-tests and one-way analysis of variance (ANOVA) were employed to examine the relationships among each demographic variable and the scores of QoL and religious attitudes. Finally, Correlation test and regression analyses were conducted to analyze the correlations between the variables of religious attitudes and QoL by controlling for the effects of other variables. Data analysis was performed using SPSS version 21, with a significance level of 0.05. The power of the test in the study is 80%.
3.6. Ethical Consideration
The present study was conducted after obtaining the code of ethics from the Abadan University of Medical Sciences (code: IR.ABADANUMS.REC.1401.110; No.: 1547). All participants entered the study with informed consent and were assured that the results would be reviewed confidentially and publish in general.
4. Results
The mean age of the participants was 21.88 years. Of the total sample, 52.5% were female and 95% were single. Additionally, 61.7% were undergraduate students, and the mean overall GPA was 16.92. Most of the participants (87.7%) lived in dormitories, and 28.4% reported being fully satisfied with their field of study. The demographic characteristics of the participants are presented in Table 1.
Table 1.Demographic Characteristics of Students Participating in the Study
| Demographic Variables | No. (%) |
|---|---|
| Field of study | |
| Public health | 17 (3.7) |
| Occupational health | 17 (3.7) |
| Environmental health | 21 (4.5) |
| Health information technology | 18 (3.9) |
| Librarianship | 13 (2.8) |
| Medical laboratory science | 31 (38.3) |
| Medicine | 177 (38.1) |
| Nursing | 92 (19.9) |
| Anesthesia | 30 (6.5) |
| Operating room | 26 (5.6) |
| Emergency medical | 20 (4.3) |
| Academic semester | |
| 2 | 152 (32.9) |
| 3 | 71 (15.4) |
| 4 | 79 (17.1) |
| 5 | 63 (13.6) |
| 6 | 72 (15.6) |
| 7 | 13 (2.8) |
| 8 | 3 (0.6) |
| 9 | 3 (0.6) |
| 10 | 3 (0.6) |
| 11 | 3 (0.6) |
| Satisfaction with field of study | |
| Completely disagree | 7 (1.5) |
| Disagree | 45 (9.7) |
| Neutral | 109 (23.4) |
| Agree | 166 (35.7) |
| Completely agree | 132 (28.4) |
| Gender | |
| Female | 243 (52.5) |
| Male | 219 (47.4) |
| Marital status | |
| Single | 438 (95) |
| Married | 23 (5) |
| Degree | |
| Bachelor | 285 (61.7) |
| Doctorate | 177 (38.3) |
| Type of residence | |
| With family | 48 (10.5) |
| Dormitory | 401 (78.7) |
| Rented | 8 (8.1) |
| Father’s education level | |
| Illiterate | 18 (3.9) |
| Middle school | 70 (15.2) |
| Diploma | 104 (22.6) |
| Associate | 47 (10.2) |
| Bachelor | 132 (28.4) |
| Master | 65 (14.1) |
| Doctorate | 22 (4.8) |
| Seminary | 2 (0.4) |
| Mother’s education level | |
| Illiterate | 30 (6.5) |
| Middle school | 85 (18.5) |
| Diploma | 157 (34.1) |
| Associate | 52 (11.3) |
| Bachelor | 79 (17.2) |
| Master | 40 (8.7) |
| Doctorate | 15 (3.3) |
| Seminary | 2 (0.4) |
The mean total score of QoL was 90.66 ± 16.02 (range: 30 - 130), while the mean total score of religious attitudes was 135.86 ± 37.26 (range: 0 - 200) (Table 2). The normality of both variables was verified using the Kolmogorov - Smirnov test, confirming a normal distribution; therefore, parametric tests were applied.
Table 2.Means and Standard Deviations of Quality of Life and Religious Attitudes, and Their Subscales
| Variables | Minimum Score | Maximum Score | Mean ± SD |
|---|---|---|---|
| QoL | 30 | 130 | 90.66 ± 16.02 |
| Physical health | 7 | 72 | 23.95 ± 5.25 |
| Mental health | 8 | 30 | 21.79 ± 4.08 |
| Social relationships | 3 | 15 | 9.55 ± 2.63 |
| Social environment | 3 | 15 | 10.62 ± 2.63 |
| QoL and general health | 2 | 10 | 7.56 ± 1.74 |
| Religious attitudes | 0 | 200 | 135.86 ± 37.26 |
| Religious belief | 0 | 60 | 41.93 ± 13.12 |
| Religious emotions | 0 | 60 | 43.95 ± 10.26 |
| Religious behavior | 0 | 55 | 31.71 ± 13.86 |
| Social pretense | 0 | 20 | 15.24 ± 3.59 |
Abbreviation: QoL, quality of life.
Independent t-tests were used to compare the mean total scores of QoL and religious attitudes based on gender, marital status, and education level. The results showed a statistically significant difference in religious attitude scores by gender (P = 0.025), with female students reporting higher religious attitudes than males. No significant difference was observed between gender and QoL scores (P = 0.479). Similarly, marital status was not significantly associated with either QoL (P = 0.945) or religious attitudes (P = 0.166). Education level also showed no significant relationship with QoL (P = 0.904) or religious attitudes (P = 0.45).
One-way ANOVA indicated no significant differences in QoL (P = 0.143) or religious attitudes (P = 0.791) across fields of study. QoL scores did not differ significantly based on residence type (P = 0.170), mother’s education level (P = 0.692), or academic semester (P = 0.692). Likewise, religious attitudes were not significantly affected by father’s (P = 0.661) or mother’s (P = 0.579) education levels (Table 3).
Table 3.Comparing Quality of Life at Different Levels of Demographic Variables
| Demographic Variables | Mean ± SD | P-Value |
|---|---|---|
| Field of study | 0.143 | |
| Public health | 91.05 ± 19.06 | |
| Occupational health | 96.58 ± 11.66 | |
| Environmental health | 90.23 ± 14.02 | |
| Health information technology | 86.94 ± 14.48 | |
| Librarianship | 89.46 ± 16.63 | |
| Medical laboratory science | 88.70 ± 18.64 | |
| Medicine | 90.54 ± 16.76 | |
| Nursing | 91.57 ± 14.98 | |
| Anesthesia | 90.46 ± 17.46 | |
| Operating room | 83.65 ± 12.42 | |
| Emergency medical | 99.100 ± 11.01 | |
| Academic semester | 0.233 | |
| 2 | 89.70 ± 15.43 | |
| 3 | 90.56 ± 13.43 | |
| 4 | 88.34 ± 16.64 | |
| 5 | 93.65 ± 14.42 | |
| 6 | 91.09 ± 19.06 | |
| 7 | 90.91 ± 12.43 | |
| 8 | 89.78 ± 15.23 | |
| 9 | 93.34 ± 14.53 | |
| 10 | 92.70 ± 18.44 | |
| 11 | 90.65 ± 16.02 | |
| Satisfaction with field of study | < 0.001 | |
| Completely disagree | 74.14 ± 15.64 | |
| Disagree | 85.20 ± 18.77 | |
| Neutral | 86.18 ± 14.28 | |
| Agree | 89.07 ± 14.11 | |
| Completely agree | 98.92 ± 15.42 | |
| Gender | 0.479 | |
| Female | 90.16 ± 15.55 | |
| Male | 91.21 ± 16.55 | |
| Marital status | 0.945 | |
| Single | 90.82 ± 16.36 | |
| Married | 90.59 ± 51.99 | |
| Degree | 0.904 | |
| Bachelor | 90.82 ± 16.36 | |
| Doctorate | 90.59 ± 51.99 | |
| Type of residence | 0.170 | |
| With family | 94.66 ± 14.52 | |
| Dormitory | 90.18 ± 16.29 | |
| Rented | 93.25 ± 11.52 | |
| Father’s education level | 0.049 | |
| Illiterate | 82.94 ± 16.75 | |
| Middle school | 91.51 ± 13.72 | |
| Diploma | 91.27 ± 16.31 | |
| Associate | 96.10 ± 14.49 | |
| Bachelor | 91.04 ± 15.85 | |
| Master | 87.26 ± 16.99 | |
| Doctorate | 86.40 ± 19.04 | |
| Seminary | 102.00 ± 24.04 | |
| Mother’s education level | 0.692 | |
| Illiterate | 88.86 ± 17.10 | |
| Middle school | 91.29 ± 13.63 | |
| Diploma | 91.19 ± 16.80 | |
| Associate | 90.07 ± 17.89 | |
| Bachelor | 91.41 ± 14.47 | |
| Master | 91.20 ± 14.47 | |
| Doctorate | 84.80 ± 18.29 | |
| Seminary | 75.50 ± 13.43 |
However, both QoL and religious attitudes demonstrated statistically significant differences across levels of satisfaction with the field of study (P < 0.001). Post hoc analysis revealed that students who were completely satisfied had significantly higher QoL scores compared to dissatisfied, moderately satisfied, and partially satisfied students (all P < 0.001). Religious attitudes also differed significantly among satisfaction groups, with completely satisfied students scoring higher than those who were dissatisfied or moderately satisfied (P < 0.05) (Table 4).
Table 4.Comparing Religious Attitudes at Different Levels of Demographic Variables
| Demographic Variables | No. (%) | P-Value |
|---|---|---|
| Field of study | 0.791 | |
| Public health | 136.28 ± 35.89 | |
| Occupational health | 134.23 ± 17.40 | |
| Environmental health | 134.31 ± 09.92 | |
| Health information technology | 139.28 ± 55.04 | |
| Librarianship | 140.34 ± 38.50 | |
| Medical laboratory science | 132.43 ± 96.83 | |
| Medicine | 137.37 ± 22.59 | |
| Nursing | 134.41 ± 31.92 | |
| Anesthesia | 139.44 ± 80.11 | |
| Operating room | 140.36 ± 69.30 | |
| Emergency medical | 140.24 ± 45.01 | |
| Academic semester | 0.233 | |
| 2 | 89.15 ± 70.43 | |
| 3 | 90.13 ± 56.43 | |
| 4 | 88.16 ± 34.64 | |
| 5 | 93.14 ± 65.42 | |
| 6 | 91.19 ± 09.06 | |
| 7 | 19.90 ± 12.43 | |
| 8 | 89.15 ± 78.23 | |
| 9 | 93.14 ± 34.53 | |
| 10 | 92.18 ± 70.44 | |
| 11 | 90.16 ± 65.02 | |
| Satisfaction with field of study | < 0.001 | |
| Completely disagree | 113.30 ± 42.06 | |
| Disagree | 113.38 ± 60.63 | |
| Neutral | 131.32 ± 33.56 | |
| Agree | 134.38 ± 66.47 | |
| Completely agree | 150.33 ± 13.85 | |
| Gender | 0.025 | |
| Female | 139.37 ± 54.25 | |
| Male | 131.38 ± 75.82 | |
| Marital status | 0.166 | |
| Single | 136.37 ± 39.48 | |
| Married | 125.32 ± 34.47 | |
| Degree | 0.45 | |
| Bachelor | 134.37 ± 82.36 | |
| Doctorate | 137.37 ± 51.59 | |
| Type of residence | 0.011 | |
| With family | 149.39 ± 60.60 | |
| Dormitory | 134.36 ± 65.85 | |
| Rented | 117.26 ± 12.78 | |
| Father’s education level | 0.661 | |
| Illiterate | 125.33 ± 83.71 | |
| Middle school | 136.39 ± 11.25 | |
| Diploma | 136.35 ± 72.57 | |
| Associate | 143.36 ± 44.11 | |
| Bachelor | 134.38 ± 17.48 | |
| Master | 133.37 ± 86.43 | |
| Doctorate | 24.38 ± 36.141 | |
| Seminary | 109.13 ± 50.43 | |
| Mother’s education level | 0.579 | |
| Illiterate | 131.40 ± 50.07 | |
| Middle school | 141.34 ± 50.07 | |
| Diploma | 13.40 ± 45.35 | |
| Associate | 138.30 ± 55.37 | |
| Bachelor | 133.36 ± 40.43 | |
| Master | 140.37 ± 72.12 | |
| Doctorate | 128.38 ± 26.94 | |
| Seminary | 117.24 ± 00.04 |
Moreover, religious attitude scores varied significantly based on residence type (P = 0.011), with students living with their families reporting higher scores. Quality of life scores were also significantly associated with father’s education level (P = 0.049), being higher among students whose fathers had seminary education. A significant difference in religious attitudes was also observed across academic semesters (P < 0.001), with a slight decline as the semester advanced (Table 4).
Pearson’s correlation analysis revealed significant negative correlations between age and GPA (r = - 0.261, P < 0.001) and between age and QoL (r = - 0.08, P < 0.001), indicating that as age increased, GPA and QoL tended to decrease. Grade point average was positively correlated with religious attitudes (r = 0.255, P < 0.001). Furthermore, religious attitudes were significantly correlated with all QoL domains — including physical health, psychological health, environment, and general health (P < 0.05) — except for social relationships, which showed no significant correlation with religious beliefs (P = 0.16, r = 0.065) or social pretense (P = 0.423, r = - 0.037). Overall, the total QoL and religious attitude scores showed a significant positive correlation (r = 0.431, P < 0.001) (Table 5).
Table 5.The Results of Correlation Coefficients Between Quality of Life and its Subscales and Religious Attitudes and its Components
| Variables | QoL | Physical Health | Mental Health | Social Relationships | Social Environment | General Health |
|---|---|---|---|---|---|---|
| Religious attitudes | ||||||
| r | 0.431 | 0.278 | 0.417 | 0.105 | 0.428 | 0.373 |
| P | < 0.001 | < 0.001 | < 0.001 | 0.024 | < 0.001 | < 0.001 |
| Religious belief | ||||||
| r | 0.387 | 0.253 | 0.377 | 0.065 | 0.393 | 0.347 |
| P | < 0.001 | < 0.001 | < 0.001 | 0.16 | < 0.001 | < 0.001 |
| Religious emotions | ||||||
| r | 0.382 | 0.212 | 0.384 | 0.092 | 0.376 | 0.381 |
| P | < 0.001 | < 0.001 | < 0.001 | 0.049 | < 0.001 | < 0.001 |
| Religious behavior | ||||||
| r | 0.400 | 0.291 | 0.366 | 0.139 | 0.383 | 0.274 |
| P | < 0.001 | < 0.001 | < 0.001 | 0.003 | < 0.001 | < 0.001 |
| Social pretense | ||||||
| r | 0.293 | 0.128 | 0.325 | 0.037 | 0.301 | 0.375 |
| P | < 0.001 | 0.006 | < 0.001 | 0.423 | < 0.001 | < 0.001 |
Abbreviation: QoL, quality of life.
5. Discussion
The present study examined the relationship between religious attitudes and QoL among medical students at Abadan University of Medical Sciences. Findings revealed that religious emotions scored highest among the dimensions of religious attitudes, while physical health was the strongest dimension of QoL. A significant positive correlation was observed, indicating that students with higher religious attitudes also reported better QoL. These results align with previous research showing similar associations in various populations. For instance, Babapour et al. found a positive link between religiosity and QoL in cancer patients, and Hasanvand Amoozadeh reported comparable findings among Welfare Organization beneficiaries (1, 13). Likewise, Bashirian et al. demonstrated that enhanced religious attitudes improved students’ mental health (14), and Shakournia and Baniasad identified a significant correlation between religiosity and self-esteem among medical students (15). Other studies have reinforced these results, highlighting positive associations between religiosity, meaning of life, spiritual health, and social well-being (16-19).
Spirituality appears to function as an important coping resource, facilitating resilience and adaptive strategies in the face of stress. According to Pargament, individuals who engage in positive religious coping perceive divine support during difficulties, experience feelings of intimacy and understanding from a higher power, and receive unconditional acceptance, all of which contribute to personal growth and endurance (20). Consistent with this study, Mahboobi et al. and Shakournia and Baniasad reported that religious emotions were the most prominent component of religious attitudes (6, 15), although Javadi et al. found belief to be the dominant dimension, suggesting that variations in demographics, culture, and measurement tools may account for differences (21).
Gender differences were also observed, with female students exhibiting higher religious attitudes, consistent with prior research indicating that women generally demonstrate stronger religiosity, possibly due to greater time allocated for spiritual activities (6). However, some studies, such as Hasanvand Amoozadeh and Mahdavinoor et al., reported no significant gender differences, reflecting contextual and cultural variability (1, 22).
Additionally, higher religious attitudes were associated with greater satisfaction with one’s field of study, higher GPAs, and living with family, suggesting that religiosity may serve as a motivational and supportive factor. Notably, both religious attitudes and QoL tended to decrease with advancing academic semesters and age, consistent with earlier findings (6, 15). These patterns indicate that although religiosity contributes positively to well-being, its expression may be influenced by educational progression and life stage. Overall, these findings reinforce the significance of integrating spiritual dimensions into student support programs to enhance coping and QoL.
5.1. Limitations of the Study
Among the limitations of this study is that the research sample was selected only from among students of Abadan University of Medical Sciences. Therefore, it is suggested that such research be conducted in other universities to increase the generalizability of the results. The participation of students from all majors studying at Abadan University of Medical Sciences was used in the present study. However, given that the amount of stressors varies across different departments at the University of Medical Sciences, this was considered a confounding factor and relevant statistical tests were used to control it.
5.2. Conclusions
Based on the findings of this study, which revealed the correlation between religious attitudes and QoL among students, it can be concluded that there is a correlation between the two concepts of religious attitude and QoL. Considering that the 11 fields studied at Abadan University of Medical Sciences have differences in terms of environmental stress factors, it is recommended to conduct more research focusing on these factors in order to further generalize the results. Also, the necessity of strengthening the religious dimension among students through the implementation of cultural programs and the provision of necessary infrastructure in universities is self-evident.
