26 ©2023 IJNP (Indonesian Journal of Nursing Practices). This is an open-access article distributed under the terms of the Creative CommonsAttribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ OPEN ACCESS Volume 7, Issue 1, June 2023, p. 26-36 Corelation of Spiritual Well-Being and Stress Level in College Students: A Correlational Study Muhammad Ari Arfianto*, Shabrina Naulal Haqqiyah, Sri Widowati, Muhammad Rosyidul Ibad Department of Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Malang, Indonesia Corresponding Author: Muhammad Ari Arfianto Email: muhammad_ari@umm.ac.id Article Info Online ISSN DOI Article History Received Revised Accepted : http://journal.umy.ac.id/index.php/ijnp : 2548 4249 (Print) : 2548 592X (Online) :10.18196/ijnp.v7i1.17914 : 14 February 2023 : 27 May 2023 : 31 May 2023 Abstract Background: Students often experience stress with varying intensity. Spiritual well-being is considered to have a role in controlling student stress levels. But there are many students who experience stress even though they already have good spiritual well being. Objective: This study aims to explore the correlation between spiritual well-being and stress levels in college students. Methods: This a cross-sectional l study involved 104 students. The sample was selected using an accidental sampling technique. The independent variable of this study was the students' level of spiritual well-being, while the dependent variable was the level of student stress. Data collection uses the Spiritual Well Being Scale Questionnaire and Hassless Assessment Scale for Students in College questionnaires which have been tested for validity and reliability. This research’s results were analyzed using the SPSS application with the Spearman Rho test. Most of the respondents had spiritual welfare in the high category, namely 82.7%. Most of the stress levels experienced by students were at a mild stress level (63.5%). Results: The study found a significant correlation between spiritual well-being and stress level among collge student (p = 0.000 ) with a correlation coefficient of -0.392. Conclusion: This study indicates that there is a significant relationship between spiritual well-being and stress levels in college students, with a weak correlation level and a negative correlation direction, this means that students who have high spiritual well-being have a lower probability of stress. Keywords: college students; spiritual well-being; stress INTRODUCTION Student’s often experience High stress due to emotional and physical tension caused as a result of academic and non-academic stimuli that occur around them (Musabiq & Karimah, 2018). Stress can also be caused by a lack of spirituality or a lack of connection with God. Therefore the spirituality of students can be increased to resolve the stress (Aditama, 2017). Students can increase worship such as reading holy books, performing religious rituals and applying spiritual behavior in everyday life. Spiritual well-being is a factor that contributes to reducing stress levels in college students (Taliaferro et al., 2009). Mental health problems are one of the most commonly suffered conditions and ranks 4th worldwide in 2013 and 2nd in 2020. The prevalence of stress based on 2013 Riskesdas data states that as many as 6% (14 million) of Indonesia's population over 15 years displayed symptoms of depression and anxiety (Ambarwati et al., 2019). Previous research involving 152 students in Indonesia found that 37.7% of respondents experienced moderate stress in the first year and 61.2% in the second year of University student (Adryana et al., 2020). The incidence of stress worldwide is also relatively high, around 75% of the adult population in America experiencing severe stress, a number that continues to increase each year (Legiran et al., 2015). In https://creativecommons.org/licenses/by/4.0/ mailto:muhammad_ari@umm.ac.id https://crossmark.crossref.org/dialog/?doi=10.18196/ijnp.v7i1.17914&domain=pdf VOL. 7 NO. 1 JUNE 2023 27 addition, more than one million (1.33 million) Indonesians experience mental health problems or stress. The high prevalence of stress in the world is evident with nearly 350 million people globally experiencing stress (Erindana et al., 2021; Musabiq & Karimah, 2018). Other research states that college students are particularly vulnerable to stress. The cause of this stress is due to changes in adult education methods where there are many assignments due with deadlines (Adryana et al., 2020; Erindana et al., 2021). In nursing students, stress is also often caused by the laboratory learning process. They often feel symptoms of stress such as anxiety when approaching practical laboratory exams (Salistia Budi et al., 2016). Nursing students’ stress also occurs towards the end of study. This condition is often caused by the student completing their thesis (Purukan et al., 2022). In addition, stress can also be caused by a lack of student spirituality or a lack of relationship with God. Spirituality one coping mechanism available to students. One way to help students manage their stress levels is by increasing the spirituality of these students (Aditama, 2017). Students can increase worship and apply spiritual behavior in everyday life. The level of spiritual well- being is a factor that contributes to reducing stress levels in students (Taliaferro et al., 2009). Students are one of the subjects who readily experience academic stress related to education while in college. This is because students carry out many academic and non-academic activities (B & Hamzah, 2020). Someone who has sound spiritually will find it easier to face and solve problems, especially when the individual is experiencing severe stress (Tumanggor, 2019; Utama, 2018). If the stress is not resolved, it can trigger other psychosomatic symptoms such as disturbed sleep patterns and lack of concentration while learning (Waliyanti & Pratiwi, 2017). Besides this, stress is also a factor that can trigger aggressive behavior including bullying (Sari et al., 2022). Spirituality is a complex concept that is unique to each individual, coupledwith a variety of experiences that are felt by most people who seek their limits and find meaning and purpose through relationships with other humans, nature, or God (Potter et al., 2021; Potter & Perry, 2009). The spiritual aspect triggers the formation of the meaning in one's life through intrapersonal interactions, interpersonal interactions, and transpersonal interactions to solve challenges that may be experienced (Aditama, 2017). The spiritual aspect is an important factor in belief that can help individuals achieve the balance necessary to maintain health and well-being through a spiritual relationship with God. Spirituality is an intrinsic factor for someone who is an important influence in solving problems (Alorani & Alradaydeh, 2018; Taliaferro et al., 2009). Spiritual well-being is a condition in which the individual has fulfilled their happiness spiritually or psychologically (Alorani & Alradaydeh, 2018). The individual's spiritual condition is a form of self- emphasis in relation to God, oneself, and the environment simulatenouslu. Spiritual well-being forms part of the needs of every individual. Someone who is spiritually fufilled will find it easier to face and solve problems, especially when the individual is experiencing severe stress (Lee, 2014; Pant & Srivastava, 2019). The concept of spiritual well-being is inseparable from the definition framework laid out by the National Interfaith Coalition on Aging (NICA) in Washington DC, which states that spiritual well-being is "the affirmation of life in a relationship with God, self, community and environment that nurtures and celebrates wholeness.” Spiritual well-being forms the basis for all aspects of a person's well-being that combines physical, psychological and social health. Spiritual health is a dynamic and fluctuating condition. It is necessary to achieve a peaceful life (Tumanggor, 2019). Spiritual well-being can be achieved by increasing religious activities. Research shows that there is a relationship between the intensity of participating in religious activities and the individual's spiritual level (Muslimah et al., 2019). This means that efforts to improve spiritual well-being can be carried out through religious activity programs. Undertaking religious activities are one way to improve coping mechanisms (Novianty & Garey, 2021). Regular religious activities can increase individuals’ ability to deal with stress. Religious activities can be carried out incidentally or planned within the educational curriculum. In Islamic-based educational institutions these religious activities are already a part of the educational curriculum (Handayani et al., 2021). Religious activities are formally programmed and must be attended by all students. In this study, INDONESIAN JOURNAL OF NURSING PRACTICES 28 respondents were students from universities with Islamic backgrounds, and therefore should have better spiritual coping mechanisms because they attend a college with an Islamic-based learning curriculum. The quantity of religious activities has been scientifically proven to increase individual spirituality, but several studies have shown that the level of stress experienced by students in Islamic educational institutions is still high (El-Azis, 2017). Other research also shows that many students at Islamic boarding schools experience stress during learning activities even though they regularly participate in religious activities (Rauzana et al., 2021). Other findings show that students' stress levels are high despite them studying at a religion- based institution (Sugiarto et al., 2023). Researchers identified a trend during a preliminary study at the research site, that 20 out of 26 students were complaining of symptoms of stress and experiencing psychosomatic symptoms such as difficulty sleeping, difficulty concentrating during learning, loss of appetite, anxiety and others. Interestingly most of the students said that they routinely participated in religious and worship activities during their study period. This study aims to identify the relationship between spiritual well-being and stress in college students. METHOD Research Design This study used a correlation description design with a cross sectional approach. Setting, population and sample The population of this study was 449 college students from the Faculty of Health Sciences, University of Muhammadiyah Malang, Indonesia. 104 respondents were selected using accidental sampling. Researchers distributed questionnaires online and then all the answers received were selected based on criteria, Respondents' answers that did not meet the inclusion criteria and were incomplete were not used. Instrument, Collection, Data Analysis Data was collected using an online data survey in March 2022. The independent research variable was spiritual well-being as measured by the Spiritual Well Being Scale Questionnaire (SWBS). The SWBS questionnaire consists of 20 statements consisting of two subscales Religion Well-Being (RWB) and Extensional Well-Being (EWB). The SWBS questionnaire uses a Linkert scale with a value of 1- 6 for each statement item. The dependent variable of the study is the stress level as measured by the Hassless Assessment Scale for Students in College (HASS/Col) questionnaire. The measuring instrument consisted of 54 questions with 4 answer choices that have a value, score 0 = never, 1 = sometimes, 2 = often, and 3 = always. Before data collection, researchers conducted validity and reliability tests. All questionnaire questions have a valid status, because the value of r count (Corrected Item-Total Correlation) > r table is 0.195. The reliability test results obtained Cronbach Alpha values, 0.903 and 0.871 and met the requirements, > 0.600 indicating that the variables used were reliable. The independent and dependent variable data types are ordinal data, Spiritual well being and stress levels are categorized into 3 levels: low, moderate and high. Data was analyzed by Sperman rank correlation analysis with SPSS version 23. Ethic The research has passed the ethical standards of the Health Research Ethics Commission at the University of Muhammadiyah Malang with number No.E.5.a/053/KEPK-UMM/III/2022. RESULT The results of the study can be seen in Table 1 and Table 2 where respondents had an average age of 21.24 years, the majority of whom were femaleHalf of the respondents were in their 3rd year of study, living at home alone (with their parents), and their parents' income was more than 5 million rupiah. In addition, almost all respondents were Muslim. This research’s results found that most of the respondents had high levels of spiritual well being and low stress levels. VOL. 7 NO. 1 JUNE 2023 29 Table 1. Demographic data (n=104) Variabel n % Age (mean, years) 21.24 Gender Male 12 11.5 Female 92 88.5 Year of study 3rd 51 49.0 2nd 27 26.0 1st 26 25.0 Religion Islam Protestan Katolik 99 4 1 95.2 3.9 0.9 Residence With parent cLive in the boarding house Others 52 35 17 50.0 33.7 17.3 Parents' income (Rupiah) 1 million – 2 million 5 4.8 2 million – 3 million 9 8.6 3 miliion – 5 million 32 30.8 > 5 million 58 55.8 Table 2. Spiritual well-being and student stress (n=104) Variabel n % Spiritual well-being Low Moderate High 0 18 86 0 17.3 82.7 Stress level Low Moderate High 66 36 2 63.5 34.9 1.9 Table 3. Relationship between spiritual well-being and student stress levels (n=104) Stress level Total Low Moderate High Spiritual well- being Low 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Moderate 6 (5.8%) 10 (9.6%) 2 (1.9%) 18 (17.3%) High 60 (57.7%) 26 (25.0%) 0 (0.0%) 86 (82.7%) Total 66 (63.5%) 36 (34.6%) 2 (1.9%) 104 (100.0%) p value (α=0.05) 0.000 (r = -0.392) Based on the results of Table 3, it can be seen that the majority of respondents who have spiritual well- being fall into the moderate stress category. The majority of respondents who had spiritual well- being in the high category experienced moderate stress. A high level of spiritual well-being had a moderate level of stress. In addition, it could also seen that there is a relationship between spiritual well-being and stress levels in students (p value = 0.000) with a coefficient of -0.392. The significance value is < level of significance (α = 5% or 0.05). It can be concluded that there is a significant relationship between spiritual well-being and stress levels in students. The coefficient value is negative, meaning INDONESIAN JOURNAL OF NURSING PRACTICES 30 that when spiritual well-being increases, it is followed by a decrease in stress levels in students. Conversely, if students experience increased stress, spiritual well-being has the potential to decrease. The level of closeness of the relationship between the two variables is sufficient, meaning that the variable spiritual well being is a factor related to the level of stress. DISCUSSION Spiritual Well-being in College Student This research showed that most students have a high level of spiritual well-being. This study did not find any students who had a low level of spiritual well-being. All students showed moderate to high spiritual well-being. These results are similar to Leung & Pong's (2021) research which also showed that the level of spiritual well-being of students at a university was at a moderate to high level. In this study, the small standard deviation of spiritual well- being indicated that there is no significant variation between the levels of spiritual well-being among college students. Therefore, students can be said to have equivalent level of spiritual well-being Students who have a moderate level of spiritual well-being showed a minimum value scale range of 58 to 86. Meanwhile, students who had high levels of spiritual well-being were in the range of a value scale of 87 to 97. The results of this study were similar to research conducted by Momennasab et al. (2019) which stated that nursing and midwifery students in southern Iran had a high level of spiritual well-being. Almost all students in this study expressed satisfaction when they prayed to God and believed that they received God's love and care. This level satisfaction felt by students shows that respondents have high indicators of religious well- being. The score results show that the highest average score is Religious Well-Being at 52.36. Most of the students described that they did not enjoy their life journey and felt dissatisfied when they undertook worship. Spirituality can be interpreted as self-knowledge, relationship with God, and a higher form of the human journey (Wagani & Colucci, 2018). The students indicated they believed that there was a real purpose in every human life along with feelings of happiness when worshiping God. They stated they believed God was a source of strength and support for them in carrying out their lives. By praying, students felt like their life became full of meaning and it was easy to complete daily activities, such as lecture activities. In addition, students believed God would always help them to solve problems regarding learning difficulties and activities that have to potential to be stressors for students. This could trigger a high level of spirituality in students because there was learning included in the curriculum that interprets religion and was associated with the application of knowledge. This process of applying good nursing knowledge related to humans and the surrounding environment shows that students also had good existential well-being. In general, sociodemographic variables such as gender, age, place of residence, parents' income and year of college entry are not directly related to spiritual well-being. It was only the respondent's religiosity thatthat was mentioned in many studies that greatly determines spiritual well-being. Religious well-being in students showed a higher value compared to existential well-being, this can be because students understand more deeply the meaning of the relationship between themselves and God compared to the relationship between humans or the environment. A good relationship with God can be considered to be capable of creating calm in a person so as to improve their overall coping skills regarding stress and subsequently be able to reduce student stress levels. One study explained that spiritual education can improve the spiritual well-being of university students (Hasanshahi & Mazaheri, 2016). In addition, a study states that college students show a high level of religiosity when they embrace a religion (Kimura et al., 2015). All respondents in this study adhered to a certain religion. This could be a factor that caused the respondent's spiritual well- being level to be at moderate and high levels. Although the majority of the respondents in this study indicated they were Muslim, it could not be demonstrated that religiou type was related to the level of spiritual well-being. Although religious adherents are more significant in higher spirituality, the type of religion has not been found to be related to the level of spirituality. Spiritual well-being is more influenced by how individuals understand and VOL. 7 NO. 1 JUNE 2023 31 carry out values in their religion (Garssen et al., 2021). Stress Level College Students More than half of the students in this study experienced mild category stress. The results of this study are contrary to results of Dyrbye et al. (2006) which found that health science students have a moderately high level of psychological stress compared to the general population. Study results from Ganjoo et al. (2021) found that as many as 92.4% of health science faculty students experienced moderate to high levels of stress. Another study stated that health science students tend to demonstrate higher levels of stress compared to applied science students due to a higher level of academic difficulty (Asdaq et al., 2021). In this study, the majority of students indicated they felt bored with lecture activities. Indeed, nearly half of the respondents experienced difficulties in completing lecture assignments, especially in crowded places. Previous research has found that student stress levels are also influenced by the kindness of the social community and acceptance in the lecture environment (Ding et al., 2021). Research supports that stress levels in students will increase when they are undergoing the final exam period (White, 2022). Sociodemographic factors can also be an influential factor in stress. Age is a factor that affects emotional mental disorders in vulnerable adolescents and young adults. This period is a period of great emotional and physicaltransition, even though during this time individuals are developing stronger self-control (Malfasari et al., 2020). However, these issues can be supported by social support or family support. More than half of the respondents in this study live with their families. Living with family is a factor that causes the respondent's stress level to be more controlled. Families have a direct influence in providing support on a daily basis (Arfianto et al., 2020). Family support factors are also strengthened by socio-economic conditions. Socio-economic conditions are also a factor triggering stress. All respondents in this study were students whose economic needs were still met by their parents. As such the income of their parents will directly affect. Parents' income is a significant factor relating to the incidence of emotional mental disorders. Adolescents with low-income parents are at high risk of experiencing emotional mental disorders (Prihatiningsih & Wijayanti, 2019). Gender factors can also affect stress, but in this study the majority of respondents were women. So no determinations can regarding the stress levels of male students, as well as the year of study factor. Other research shows that the year of college is not significantly related to the occurrence of stress. This tendency is caused because at each year level students have different and unique stressor characteristics, so that each level of education has the same level of stress (Melizza et al., 2022). Stress on students is often caused by physical and family problems, pressure to meet high success standards, social and emotional problems, and final assessments on campus (Murphy et al., 2010; Yusoff et al., 2013). College students have good relationships with their families and friends. This psychological stress can be reduced with emotional coping to deal with stressors and support from friends and family (Akbar & Aisyawati, 2021). In addition, listening to music, chatting with friends and parents, sleeping, and doing activities according to hobbies can reduce stress levels in students (Sreeram & Mundada, 2021). Even though sometimes students in this study indicated they felt that communicating with classmates or study groups was not pleasant, they still considered that the communication they onduted was a normal thing for every student to experience. This study found that students who experienced severe levels of stress were female. This result is supported by a study which proves that women are more prone to experiencing academic stress in lectures compared to men (Graves et al., 2021). Correlation of Spiritual Well-being and Stress level The Spearman Rho correlation test showed that p value was 0.000 (p<0.05). These results indicate that there was a significant relationship between spiritual well-being and stress levels in nursing students. In addition, the research results shows that increasing spiritual well-being can reduce student stress levels (coeff. -0.392). The coefficient value in this study indicated that the relationship between spiritual well-being and student stress levels was weak. In this study there were factors other than spirituality that can trigger stress, such as age, gender, biological, psychological, INDONESIAN JOURNAL OF NURSING PRACTICES 32 and physical conditions. Respondents who were older were likely able to apply stressor control strategies more frequently and effectively compared to young adults or adolescents which aim to reduce or prevent the negative effects of stress (Scott et al., 2013). Gender can also be a factor in the occurrence of stress on a person. This can be due to differences in the hormonal system between men and women, differences in gonadal steroids and menstrual cycles, psychoneuroimmunological markers, the relationship between neuroimaging and problem-solving strategies, genetics and a person's character, as well as cognitive structure. Genetically (biologically), susceptibility to coping with stress, a person's character type, and social support are significantly related to the occurrence of stress. In addition, a person's psychological condition is also greatly influenced by physical and psychological conditions. The results of the univariate test based on gender found that the majority were women, with a total of 92 (88.5%). Male studentshad the least number of respondents, namely 12 with a percentage of 11.5. Almost half of the respondents in this study were in the 2018 cohort(49%). There was no significant difference in the number of respondents for the 2019 and 2020 batches. Taking the research sample using the cluster sampling method caused an imbalance in the number of research respondents in each class. There were 2 times the amount of respondents from the 2018 class group than from the 2019 and 2020 class groups. The limited face-to- face student learning process made it difficult for students to understand the learning material presented by lecturers in the lectures. According to research by Cao et al. (2020) and Li et al. (2021) stressors for students during the Covid-19 pandemic were limited campus access, delayed graduation processes, and unclear expectations for future jobs. The decline in intra-campus learning activities presented a a challenge for students and increased the incidence of stress on students (White, 2022). According to Gade, Chari, & Gupta (2014), problems related to academics are a cause of high stress on health science students. The results of this study were supported by previous research which states that the spiritual well-being of college students was related to the emergence of 3 symptoms of psychological disorders, such as stress, anxiety, and depression (Leung & Pong, 2021). A study also found that spiritual well-being in the personal and communal domains had a significant relationship on the presence of stress symptoms in college students (Lee, 2014). Students who had a high level of spiritual well-being had a mild level of stress. Students who believe in a religion had a high level of religiosity, but this variable had a weak relationship with stress events (Kimura et al., 2015). Students who had moderate levels of spiritual well- being still had the possibility of experiencing severe levels of stress. Students who had severe levels of stress said that they often received unpleasant treatment from the people around them and did not have high satisfaction in their relationship with God. Meanwhile, students who believed in deep spirituality in life can provide a strong meaning in life (Wagani & Colucci, 2018). These students felt that they did not have a clear enough purpose in life. This lack of meaning and purpose in life caused a feeling of helplessness and lack of resilience (Wagani & Colucci, 2018). Students who have a clear purpose in life show low psychological disorders (Schafer, 1997). However, in this study, students with moderate levels of spiritual well-being still had the possibility of experiencing severe levels of stress. Students with severe levels of stress said that they often received unpleasant treatment from the people around them and did not have high satisfaction in their relationship with God. Meanwhile, students who believed in deep spirituality in life can provide a strong purpose in life (Wagani & Colucci, 2018). Poor student relationships with family and friends can be a contributing factor to high stress. This is due to a lack of support for students in carrying out lecture assignments. In addition, psychological parenting mistakes during childhood on college students have a negative impact on spiritual well-being directly and indirectly (Arslan, 2021). However, in depth communication between students and their families can reduce student stress levels related to their spiritual well-being. CONCLUSION This study demonstrates that there is a relationship between spiritual well-being and stress levels in VOL. 7 NO. 1 JUNE 2023 33 college students with a weak correlation level and the direction of a negative relationship means that if spiritual well-being increases, it is followed by a decrease in stress levels in college students. The weak level of coefficient correlation indicates that apart from the spiritual well-being factor, there are also other factors that affect the stress level of students. These factors need to be investigated further in subsequent studies. The results of this study also recommend the importance of programs to improve student spirituality as a source of coping mechanisms to manage stress during the academic semester. The results of this study indicate that the spiritual well-being of students can improve student performance and their completion of learning activities. In addition, low stress levels can trigger students to be more enagaged in participating in academic and non-academic activities, which subsequently may generate more productive and innovative students. Therefore, educational institutions can collaborate with nurses to provide spiritual enhancement therapy programs for students in order to minimize stress levels. ACKNOWLEDGEMENT The researchers express their gratitude for the funding from the Faculty of Health Sciences University of Muhammadiyah Malang, with the assignment letter. The researchers also thank to the all participants who contributed to the application of the research. REFERENCES Aditama, D. 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