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Prediction of Psychological Well-Being Based on Islamic Lifestyle and Coping 
Strategies in Patients with Major Thalassemia in Tehran 

 
Asghar Ghorbani 

Dr., Pediatrician and Assistant Professor 
Tehran University of Medical Sciences 

Office of Vice-Chancellor for Global Strategies and International Affairs, 
21, Dameshgh St., Vali-e Asr Ave., Tehran 1416753955, Iran 

Phone: (+98 21) 8889 6692 
bartar.article@gmail.com 

 

Parastoo Rahimi 
M. A. Student degree on General Psychology 

Faculty of Humanities and Social Sciences, Department of Psychology 
Isamic Azad University, Science and Research Branch 

Science and Research Branch, Daneshgah Blvd, Simon Bulivar Blvd, 14515/775, Tehran  
Phone: 44865179-82 & 44865154-8 

 

Marjan Amoo Khalili 
Islamic Azad University, Roudehen Branch 

Researcher in Mysticism and Ethic Philosophy of Indian Religions and Ibrahimi Religions 
PO Box: 189, Roudehen, Tehran, Iran 

Phone: (+9821)76505015-24 (+9821)76505891-9 
 

Mojtaba Ebrahimi 
MD, Thalassemia Center of I.B.T.O, Iran 

 
 Abstract 
 Background: This study aimed to predict psychological well-being based on Islamic lifestyle 
and coping strategies in patients with thalassemia major in Tehran.   
 Method: The present study was categorized as descriptive research (correlation type) as the 
research method. Because the aim of the research was to determine the contribution and role of each 
of the predictor variables in estimating and predicting the criterion variable. For this purpose, this 
study included all major thalassemia patients referring to Zafar Thalassemia Clinic and Thalassemia 
Department of Baharlo Hospital in Tehran.  
 Results:According to the results, coping strategies (coping focused on cognitive assessment, 
coping focused on problem solving, emotion-focused coping, social support, and coping focused on 
physical inhibition) have significantly improved psychological well-being in people with major 
thalassemia disease, as predicted, and also the Islamic lifestyle significantly predicted psychological 
well-being in people with major thalassemia.  
 Conclusion: Among coping strategies, coping focused on problem-solving, coping focused 
on positive cognitive assessment, coping focused on emotion and coping with physical inhibition 
for significant negative psychological well-being in patients with thalassemia major the study 
predicted and found that the Islamic lifestyle has a positive psychological well-being in patients 
with thalassemia major.  
 

Keywords: Islamic Lifestyle, Major Thalassemia, Coping Strategies, Psychological Well-Being. 
 
 1. Introduction 
 The World Health Organization (2002) identified Thalassemia as the most commonly 
diagnosed chronic genetic disorder among 60 countries, affecting the lives of 100,000 children a 
year. In our country, it is one of the most commonly encountered genetic cases (Akbarbaglo and 
Habibpour, 2010, 2003). The World Health Organization, estimated the world's mental disorder, 
11.5% in 1998. The statistics show that in 2020, the disorder will be up to 15%, and the 



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disappointment and anxiety of humans will be a burden on the community. Since the physical 
problems of these patients cause many mental and psychological problems, it is imperative that 
effective psychological well-being, such as Islamic lifestyle and coping strategies, be considered 
and the necessary strategies to promote these patients be provided to patients and their families for 
comfort, and a positive step to increase the useful life and promotion of social performance and 
quality of life.  In case of neglecting different physical, mental, and even economic dimensions, 
these people will experience many problems including social isolation, depression, anxiety, reduced 
social and educational performance, dissatisfaction with life, low life expectancy and even suicide. 
The hope for life and the belief in spiritual and transactional issues will increase the acceptance and 
the follow up of interventions by the individual.  
 The present study was conducted with the aim of "predicting psychological well-being 
based on Islamic lifestyle and coping strategies in major thalassemia patients in Tehran". The 
overall aim of this study is to predict psychological well-being based on Islamic lifestyle and coping 
strategies in patients with major thalassemia in Tehran. The minor objectives of the research are: the 
prediction of psychological well-being based on coping strategies in patients with thalassemia in 
Tehran; and prediction of psychological well-being based on Islamic lifestyle in patients with 
thalassemia in Tehran. To test the hypotheses, hierarchical multi-variable regression analysis was 
used. This research is categorized as a descriptive study type (correlation type).  
 This research is categorized as a retrospective research in terms of research design. In terms 
of purpose and type of research, the present study was conducted in the applied research group. In 
this research, three questionnaires were used: the Rief Psychological Well-Being Questionnaire 
(RPEBS), the Billings and Meus Coping Strategies Questionnaire, and the Kaviani Lifestyle 
Lifestyle Questionnaire, self-report. The participants responded with help from the researcher's 
explanations. The statistical population of this study was thalassemia major patients in Tehran. 
People who did not have a history of psychiatric hospitalization and did not participate in 
workshops and psychology classes were included in the study. Also, people aged 17 and above 
were studied. 
 The paper's structure is as follows: In the next section, papers and studies that address this 
issue are reviewed. Then, the research variables (mean, standard deviation, and internal 
consistency) are described. In the next section, the assumptions of regression analysis have been 
examined and finally the research hypotheses have been tested. In the final section, we will draw 
conclusions from the findings. 
 
 2. Method  
 In this study, 97 participants (64.7%) were women and 53 others (35.3%) were male. Also, 
32 participants (21.3%) were under 25 years of age, 35 of them (23.3%) were 26-30 years old, 37 
(24.7%) were 31-35 years old and 46 (30.7%) were over 36 years old. It should be noted that the 
mean and standard deviation of the participants' age was 33.29 and 8.58, respectively. The level of 
education of 71 participants (47.3%) have diplomas and certificates, 20 (13.3%), 40 (26.7%) and 17 
(12%) have Master’s degrees and higher. In addition, 81 of the participants (54%) were single, 63 
of them (42%) were married and 3 (2%) of them were with their spouses. It should be noted that 
three of the participants did not determine their marital status. In terms of job, 20 participants 
(13.3%) were unemployed, 25 (36.7%) employees, 29 (19.3%) were employed, 34 (22.7%) had 
household activities and three (2%) were retired. It is noteworthy that nine of the participants did 
not determine their job status. 

Prior to testing the hypotheses, the mean, standard deviations and Cronbach's alpha coefficients 
were coping strategies (coping focused on cognitive assessment, coping focused on problem solving, 
emotional focused coping, social support and coping focused focus on physical inhibition), The Islamic 
lifestyle and psychological well-being are calculated and presented in Table 1. 

 



A. Ghorbani, P. Rahimi, M. A. Khalili, M. Ebrahimi - Prediction of Psychological Well-Being Based on Islamic Lifestyle 
and Coping Strategies in Patients with Major Thalassemia in Tehran 

19 

Table 1. Mean, standard deviation and Cronbach's alpha coefficient Coping strategies, Islamic lifestyle and 
psychological well-being 

Variable 
Mean 

Standard 
deviation 

Cronbach's 
alpha 

Coping strategies- Conflict focused on cognitive assessment 9.55 2.96 0.679 
Coping strategies-Conflict focused on problem solving 5.75 1.89 0.613 

Coping strategies-Conflict focused on excitement 14.93 5.28 0.810 

Coping strategies-Focused counter proliferation of social 
support 

6.33 2.05 0.694 

Coping Strategies - Focused Focus on Physical Inhibition of 
Islamic life style 

6.91 3.82 0.745 

 208.75 24.85 0.975 
Psychological well-being 76.16 9.29 0.763 

 

 Table 1 shows the mean, standard deviation and Cronbach's alpha coefficients of the 
research variables. As you can see, the Cronbach alpha coefficient for all components of the present 
study is close to or above 0.7. This indicates the acceptable internal consistency of the 
questionnaires used to measure the variables of the present study. 
 Correlation coefficients between the variables of the research showed that coping strategies, 
three coping strategies focused on cognitive assessment, coping focused on problem solving and 
coping focused on gaining social support were positively and at a meaningful level of 0.01, and two 
focused coping strategies on excitement and coping focused on physical inhibition were negatively 
correlated with psychological well-being at a significant level of 0.01. Also, Islamic lifestyle was 
positively correlated with psychological well-being at a significant level of 0.01. 
 Table 2 shows the values of elongation, skewness, inflation factor variability (VIF) and 
tolerance coefficient of research variables. 
 

Table 2. Stretch, skewness, Tolerance coefficient and inflation variance of research variables 
Variable Skewness Stretch Coefficient of 

bearing 
Variance 

Inflation (VIF) 

Coping strategies- Conflict focused on 
cognitive assessment 

0.119 0.395 0.519 1.926 

Coping strategies-Conflict focused on 
problem solving 

-0.208 0.190 0.635 1.575 

Coping strategies-Conflict focused on 
excitement 

0.772 0.162 0.750 1.333 

Coping strategies-Focused counter 
proliferation of social support 

-0.069 -0.476 0.675 0.482 

Coping Strategies - Focused Focus on 
Physical Inhibition of Islamic life style 

0.836 0.190 0.895 1.117 

 -0.237 -0.417 0.630 1.586 
Psychological well-being 0.108 - -0.082 Criterion variable Criterion variable 

 

 In order to evaluate the assumption of the normalization of the single-valued distribution, 
the values of elongation and skidding were evaluated to determine the coherence assumption of the 
factor of inflation variance (VIF) and coefficient of tolerance. As Table 2 shows, the indexes of slip 
and elasticity of any of the components have not crossed the 2 ° boundary. Therefore, it can be said 
that the distribution of data related to those components is normal. The results of Table 2 show that 
the co-existence problem in the research variables has not occurred. Because the tolerance 
coefficient for all predictive variables was higher than 0.1 and the inflation factor for variance of all 



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of them was less than 10. According to Meyer, Gamst and Guarino (2006), the coefficients of 
tolerance of less than 0.1 and the factor of inflation variance greater than 10 represent a coherence. 
 In order to test the independence of errors among the predictor variables, the value of the 
Watson Camera Index was evaluated, the value of the index was 1.763. Filed (2006) believes that 
the value of the Watson Camera Index above 2 indicates a lack of independence of error. Based on 
the value of the Watson camera index value, it can be said that the assumption of the independence 
of errors is also found among the research data. 
 One of the other assumptions of regression analysis is the normalization of multivariate 
distribution. Analysis of data relating to "Mahlonobyz distance (D)" and drawing its distribution 
curve showed that the combination of predictive variables is in explaining the normal criterion 
variable (Figure 1). Thus, it was concluded that the assumption of the normalization of multivariate 
distribution is also present among the data of the present study. 

 
Figure 1. Histogram and box plot diagrams for Mahlonobay distance (D) 

 

 3. Results  
 We are now investigating research hypotheses. The first hypothesis is that coping strategies 
(coping focused on cognitive assessment, coping focused on problem solving, emotion-focused 
coping, social protection-focused coping and focused concenter on physical inhibition) significantly 
impart psychological well-being to people with major thalassemia.  The second approach is that the 
Islamic lifestyle significantly predicts psychological well-being in people with major thalassemia. 
 The research hypotheses were tested using a multivariable regression analysis with 
hierarchical approach. In the first stage, coping strategies and in the second stage of Islamic life 
style as predictive variables were analyzed. In this study, the psychological well-being of patients 
with thalassemia major was a criterion. Table 3 shows the results of multivariable regression 
analysis in predicting the psychological well-being of patients with thalassemia major based on 
coping strategies and Islamic lifestyle. 
 

Table 3. Hierarchical Multivariate Regression in Predicting the Psychological Well-being of Patients with 
Thalassemia Major Based on Coping Strategies 

Variables of first stage (coping 
strategies) 

B SE β T Significance 
level 

R2 adjR2 

        
Conflict focused on cognitive 
assessment 

0.533 0.253 0.170 2.106 0.037   

Conflict focused on problem solving 0.990 0.357 0.202 2.769 0.006   
Conflict focused on excitement -

0.456 
0.118 -

0.259 
-

3.856 
0.001   

Coping with social support 0.324 0.319 0.072 1.015 0.312   
Focused on physical inhibition -

0.350 
0.149 -

0.144 
-

2.347 
0.020   

0.001<P26.313)=1.144(F      0.447 0.459 



A. Ghorbani, P. Rahimi, M. A. Khalili, M. Ebrahimi - Prediction of Psychological Well-Being Based on Islamic Lifestyle 
and Coping Strategies in Patients with Major Thalassemia in Tehran 

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 The first hypothesis can be examined using Table 3. Based on the results of Table 3, coping 
strategies that entered the psychological well-being prediction equation in the first stage predicted it 
at a significant level of 0.01 (p <0.01, 313.26 = (144.1) F). Multiple correlation squared analysis 
showed that the value of the multiplicity correlation coefficient (R2) is 0.447. This shows that 
coping strategies have explained 44.7% of the variance of psychological well-being.  
 Regression analysis showed that coping strategies, problem-centered coping (p <0.01, β = 
0.202) and the coping focused on cognitive assessment (p <0.05, p <0.05) positively and at levels of 
0.01 and 0.05, respectively, predicts psychological well-being in people with major thalassemia. 
Also, the focus on emotion (p <0.01, β = -0.259), and coping focused on physical inhibition (P 
<0.05, β = -144 / 0), respectively, were negatively correlated at the significant levels 0 and 0.05 
predicted psychological well-being in people with major thalassemia. Thus, in the first hypothesis 
test, it was concluded that a combination of coping strategies, problem-centered coping-focused 
coping focused on cognitive assessment and positive-focused coping focused on emotion and 
coping focused on physical inhibition were negatively and significantly predictive of psychological 
well-being in people with major thalassemia. 
 

Table 4. Hierarchical Multivariate Regression in predicting psychological well-being of patients with 
thalassemia major based on Islamic lifestyle 

Variables of 
second stage 
(Islamic life style) 

B SE β t  سطح
 معناداری

R2    adjR2 

        
 0.094 0.027 0.252 3.444 0.001   
        
0.001< 25.559,P)=6.143(F 
0.01<P  ، 11.862=∆F 

 
 

0.040=R2∆ 0.517 0.497 

0.01 <P    ،  **0.05 <P*   
     

 
 The second hypothesis can be considered in accordance with Table 4. Table 4 shows that 
with the entry of Islamic lifestyle to the prediction equation in the second stage, the value of R2 
reached 517/0. This finding means that the entry of Islamic lifestyle into the prediction equation has 
led to 51.7% of the variance of psychological well-being. The value of R2 (R2Δ) changes was 0.40. 
This finding means that with the introduction of the Islamic lifestyle in the prediction equation and 
by controlling the effect of coping strategies, the value of the explained psychological well-being is 
increased by 4%, which is statistically significant at the level of 0.01 (P <0.01), 862/11 = ΔF). 
Regression analysis also showed that the Islamic life style was positively predicted at the significant 
level of psychological well-being in patients with thalassemia major. (P <0.01, 252/0 = β). Thus, in 
the second hypothesis test, it was determined that the Islamic lifestyle positively and significantly 
predicts psychological well-being in people with major thalassemia. 
 
 4. Discussion  
 The first hypothesis was that psychological well-being is predictable based on coping 
strategies. For analyzing the hypothesis, hierarchical multi-variable regression analysis was used. 
According to the analysis of the data, the results of our hypothesis were confirmed. The results 
obtained by Yazdi research (2004), Mirand (2013), Ghazanfari (2008), Comps et al. (1988), 
Zenozian et al. (2010), Brilliant (2014), Gray (2004), Ziegler (1999), Yang Chua (2016), Salehian 
(2014), Babapur et al. (2016), Khosravani (2012).  
 In explaining the results, it can be said that problem-oriented skills are cognitive skills that a 
person performs and realizes with regard to position, accurate evaluation, separation from his 
emotions and emotions, and more these effective coping methods of physical symptoms and 



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psychological symptoms will show anxiety, lack of satisfaction and lack of satisfaction of life and 
will have a higher level of well-being and positive affection. The use of ineffective (emotional) 
coping styles makes people more vulnerable to stress situations and provides grounds for emotional 
disturbances and psychological incongruity and lack of mental well-being. The use of emotion-
focused strategies eliminates the direct and effective involvement of the individual and reduces the 
individual's ability to solve the problem, and this disrupts the mental consistency and emotional 
turmoil and reduces mental well-being.  
 People who experience a positive life-span lead to a greater life expectancy in life are more 
capable of enduring adverse conditions, which leads to psychological well-being of individuals. In 
fact, people who have a positive orientation experience life more.  Psychological well-being is at a 
higher level, and positive emotions (happiness, vitality, will) are more and less negative emotions 
(depression and anxiety). According to the literature, the meaningfulness of life causes a person to 
feel efficient and self-worthy and purposeful in life, and when individuals are purposeful in their 
lives, they have a sense of efficiency and control, and have a sense of self-worth. In this way they 
are able to face up to failures, Life calamities and conflicts, and even positive events, advances and 
responsibilities continue to work and work to succeed. Increasing the use of the excitement strategy 
matches the increase in anxiety, physical injury, and depression, and the reduction in the use of an 
orbital problem strategy matches the increase in social function disorder. Thus, the excitement 
mode is more effective on physical and emotional symptoms, while the more orthogonal problem 
affects individual interactions and social functioning of the individual. 
 The second hypothesis was that psychological well-being based on the Islamic lifestyle is 
predictable. For analyzing the hypothesis, hierarchical multi-variable regression analysis was used. 
According to the analysis of the data, the results of our hypothesis were confirmed. The results 
obtained by Kajbaf et al. (2011), Nikoquar et al. (2014), Babapur et al. (2014), Nourmohammadi, 
Najaf Abadi (2014), Nozari (2014), Dehghan (2014), Arshiyan Mehr (2014) Salam Abadi (2014) 
have been consistent. 
 
 5. Conclusion  
 The results showed that the components of the Islamic lifestyle, components of beliefs, 
family, financial and health, have predictive power of psychological well-being. Religious behavior 
and beliefs have a positive effect on meaningfulness of life. Behaviors such as trusting in God, 
worship, pilgrimage... can create inner peace by creating hope and encouraging positive attitudes. 
Having meaning and purpose in life, feeling belonging to a higher source, hoping for God's help in 
difficult living conditions, enjoying social and spiritual protection, etc., are all methods that 
religious people by having them, can suffer less damage in the face of life-pressures. Believing that 
there is a god controlling the situation and considering servants, to a large extent, reduces the 
anxiety associated with the situation, so that most believers often associate themselves with God, 
like a very intimate friend, and they argue that it is possible to control the effect of uncontrollable 
positions in some way through reliance and appeal to God. Individuals with internal control are 
more likely to observe aspects of health and well-being care, such as weight management, exercise, 
smoking and preventive care, because individuals with internal control sources are determined by 
trying to find information that enables them to have more control over themselves and their 
environment. That's why it is their own promotion of their well-being. In addition, life based on the 
Islamic model means life based on the teachings of the Islamic religion, in which God remembers 
the relaxing of the hearts (Raad Surah, 21). Such teachings reduce feelings of anxiety, depression 
and inefficient attitudes. 
 This research was confronted with limitations: there was no research on the psychological 
dimension and psychological well-being of patients with thalassemia major. Also, because of the 
fatigue caused by the number of questions, patients may be responsive to the questionnaire in a 
careful manner, and the reliability on the results should be cautious. It should be noted that this 



A. Ghorbani, P. Rahimi, M. A. Khalili, M. Ebrahimi - Prediction of Psychological Well-Being Based on Islamic Lifestyle 
and Coping Strategies in Patients with Major Thalassemia in Tehran 

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research is related to Thalassemia patients in Tehran. Therefore, generalization to other areas and 
other patients and different ages should be done with caution.  
 Suggestions for future studies: Researchers with similar research on other subjects and other 
statistical communities are recommended. In another studies, the relationship between the variables 
of this research and other psychological variables such as quality of life, self-esteem, determination 
and assertiveness, and others, can be considered.  
 
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