The relationship between spiritual health and happiness among the students of health Sciences in Guilan University of Medical Sciences

Background: Spirituality and spiritual health are important concepts among human societies, and the relation of these concepts to other scientific ones is important for health professionals. The purpose of this study is to investigate the relationship between spiritual well-being and happiness among the Methods: This is a cross-sectional and descriptive-analytic study carried out among 322 students through census sampling method. The Spiritual Health Questionnaire (SWBS) was made by Pulotsin and Ellison in 1982 and used to measure spiritual well-being. Oxford Happiness Questionnaire (OHI) was used to measure happiness designed in 2007 by Argyle. Validity and reliability of two questionnaires are higher than 0.90. Cronbach's alpha in each dimension of spiritual well-being and also happiness in the present study was higher than 0.7. Results : The mean and standard deviation of spiritual health were 55.82±4.71 and the mean and standard deviation of students' happiness was 60.88+-12.9. There is no statistical correlation between spiritual health with any of the demographic variables. It means that the average spiritual health is not significantly different at different ages or between single students and married students. Conclusion: The results showed that there is a positive and significant relationship between spiritual well-being and happiness. Also, there is a meaningful relationship between all aspects of spiritual health with happiness. The findings of this research illustrate the happiness is reduced by increasing the average age.


Background
Spirituality is one of the fundamental concepts among humans and has been considered remarkably by psychologists and mental health professionals in recent decades as a global phenomenon [1,2].
The most important dimensions of health are physical, psychological, spiritual, emotional and social aspects.
In fact, spiritual wellbeing is the newest recognized health dimension that has been placed alongside other dimensions of health [3]. Most health models focus on spiritual health [4]. Spiritual health is characterized by features such as stability in life, feelings of association with "self", God, society, and other creatures and being purposeful in life [5][6][7][8]. Spiritual health involves three dimensions including cognition, emotions, and action. Spirituality indicators are not just the part of psychological behaviors or emotions, such as internal satisfaction or internal peace, but also spiritual well-being focuses on all human life aspects [9][10][11] Based on the conducted studies, spiritual health can affect the quality of life [12].
Another factor associated with spiritual health is the happiness that results from personal judgement about how to live. This judgment is not imposed from the outside, but rather a personal and internal affair that is affected by the positive excitement. Happiness is one of the most important ways of prevention and treatment of mental disorders [13][14][15]. It is a condition of the cheerfulness or joy (positive emotions), being satisfied with life, and the lack of depression and anxiety (negative factors) [16,17].
An extraordinary force existing in spiritual health gives the person a spiritual power and distracts him/her from anxiety and worries [18,19]. In sum, it can be said that spirituality and spiritual health play a major role in the mental and physical health of individuals and it is considered as a useful way to deal with psychological problems, including depression [20,21]. Depression is a common disorder that is one of the most serious physical and mental illnesses and its prevalence rate in the world is 10-20% per year. Approximately 15% of the total population experiences a period of major depression in an episode of their lives [22,23]. Students' populations are prone to be depressed and depressed students face more problems in their curriculum, and their grades are lower than other their counterparts [24]. The results of published studies in Iran indicate that prevalence of depression among university students is between 36% and 66%.Around 2 to 5% of them suffering from severe type of disorder [25,26]. Also, in some studies, happiness and its role in satisfying students' lives are investigated [27,28]. Promoting spiritual well-being in universities is often recommended. Therefore, in addition to the skills required for students, it is also necessary to gain spiritual skills [29,30]. The purpose of this study was to determine the spiritual health and its relation with happiness among the students of health sciences of Guilan University of Medical Science. The determination of the relationship between each aspect of spiritual health with happiness in the studied population, could be the basis of planning for promotion of happiness among students, because investing in universities to improve the spiritual health of students can lead to a reduction in depression, increasing happiness, and, ultimately, academic achievement among them.

Study design
This is a descriptive-analytic and cross-sectional study. The statistical population included all students of Health Sciences studying in Guilan University of Medical Sciences in the first semester of the academic year 2016-2017. The students were entered into the study by census method. The number of investigated students was 323. The data collection tool was a questionnaire. The SWBS spiritual health questionnaire designed by Pulotsin and Ellison in 1982 and used to measure the spiritual health. It consisted of 20 questions categorized based on Likert's 5-choice (totally agree, agree, no opinion, opposite, totally opposite). The score for each of the responses was scaled from 1 to 5. The spiritual health score is the sum of the scores of three dimensions of cognition, action, and emotion ranging from 120 − 20. The Farsi version of this scale was adapted and divided into these dimensions.
In terms of the positive verb, the "totally agreeable" scores 5 and the "totally opposite" scores 1. The expressions with a negative verb lead to reverse the scores. This questionnaire has been used by other scholars in Iran and its validity and reliability have been verified [31]. To measure happiness, Oxford Happiness Standard Questionnaire (OHI) was used developed by Argyle in 2001. The questionnaire contains 29 quadrants questions (always, sometimes, rarely, and at all) and the scores for them are 4, 3, 2, and 1, respectively. The range of happiness score is between 87 − 0. The validity and reliability of this questionnaire were measured by AliPour and Agah Harris. The results showed that it has appropriate validity and reliability for measuring the happiness in the Iranian society [18].
Also, The Farsi version of this scale was adapted. According to Mozafari Nia and his colleagues' findings, validity and reliability of the two questionnaires are higher than 0.90 [32]. Cronbach's alpha in each dimension of spiritual well-being and also happiness dimensions in the mentioned study were higher than 0.7. Exclusion criterion was the unwillingness to participate in the study. SPSS 16 and descriptive statistical methods including frequency distribution and mean indices, standard deviations and analytical statistics including Spearman correlation, Mann-Whitney and Kruskal tests were used in order to analyze the data,

Results
In this study, 93% of students were females and the mean and standard deviation of students' age was 24.61 ± 7.62. 70 percent of students were single and their average level of interest to their study was up to 80 percent. 82% of them were domestic in that region (  There was no statistically significant relationship between spiritual health with any of the demographic variables, which means that the mean of spiritual health in different ages was not significantly different. Besides, spiritual health was not significant between single students and married people.
The following table shows the correlation coefficient between spiritual health and its dimensions and happiness.

Discussion
The aim of this study was to determine the relationship between spiritual well-being and happiness among students of the Faculty of Health of Guilan University of Medical Sciences. The results showed that there was a positive and significant relationship between spiritual well-being and happiness.
There is also a significant relationship between all aspects of spiritual health with happiness that is consistent with the study of Mozafari Nia et al. [32]. In this investigation, there was a significant relationship between spiritual well-being and marital status, which was consistent with the studies of Mozafari Nia et al. and Ebadi et al [32,33].
The results of this research indicated that spiritual well-being had significant relationship with age group and decreased with age increase. The highest level of health belonged to the age group under the age of 20 with the mean (standard deviation) of 56.56 (4.15), then, the age ranging from 20 to  [34]. Spiritual health had a significant relationship with marital status, so that the average spiritual health in single students (56.10 ± 4.74) was more than married (55.20 ± 4.61) ones. It is compatible with the study of Tavan and colleagues [34].
In this study, there was no relationship between gender and spiritual well-being, which is consistent with the studies of Asaroodi and Allah Bakhshian [35,36]. There was no relationship between educational level and housing situation with spiritual health, which was matched with Mozafari Nia et al's investigation [32]. The results of this study illustrated that age had the negative relation between happiness and the increasing of age. This result was consistent with the study of Bradburn [37] Overall, the relationship between age and happiness has not been clearly identified. In other studies, positive results and negative correlations were found. Some investigations also showed no correlation [38]. The results of Bradburn's study indicated that the level of happiness decreased by increasing every ten years. 8 percent of people are not happy at the age of 20, and for people at the age of 50, this percentage is up to 17. Also, the results of this study demonstrated that there was is not the significant relationship between happiness and gender, which is in agreement with the results of the study of Kiwomah Hanankan [39]. In this research ,there was a significant relationship between happiness and marital status, which was consistent with the results of the studies of Mastkasa and Abedi [33,40]. In their research, they revealed that the happiness of married people was greater than that of single people. The findings of this study showed significant relationship between interest in the field of study and happiness. There was a significant relationship between happiness and educational level which was consistent with Abedi et al's investigation. In general, it cannot be said that the higher the education, the higher the happiness. But as people with higher education may earn at least as much as their basic living needs, their low level of happiness might not be the case. But there is no definite relationship between education and happiness [41].

Conclusion
The results showed positive and significant relationship between spiritual well-being and happiness.
Also, there was a meaningful relationship between all aspects of spiritual health with happiness. The results of this investigation illustrated that as the average age increased, happiness decreased.
Considering the importance of happiness for students, it is suggested that spiritual well-being should be considered as one of the important factors in increasing the happiness of student.

Acknowledgments
Our grateful thanks go to all participants in the present study.

Authors'contributions
EF and PK contributed to the design, RFH, AZ and AA statistical analysis, participated in most of the study steps. FK and MN and MRG prepared the manuscript. E R and AR assisted in designing the study, and helped in the, interpretation of the study. All authors have read and approved the content of the manuscript.

Funding
There was no source of funding.