INTRODUCTION
Stress is considered one of the most important public health problems worldwide [1,2]. Furthermore, it is recognized as a significant risk factor for both physical and mental health [3]. Additionally, it is a psychological problem that can act as a precipitating or exacerbating factor for a multitude of diseases and pathological conditions [4]. Internationally, the prevalence of stress is of great concern. A review study found that the prevalence of stress was 29.6% during the coronavirus disease-2019 (COVID-19) pandemic in Asia and Europe [5]. Similarly, Ugbolue et al. [6] reported in their study conducted in 67 countries on five continents that the increase in stress levels following the onset of the COVID-19 pandemic reached 21.8%. On the other hand, in the context of Peru, the prevalence of stress is also noteworthy. For example, Boluarte-Carbajal et al. [7] reported that 65.2% of Peruvians over 18 years of age exhibited at least one mental health condition (depression, anxiety, or stress symptoms). Finally, the World Health Organization defines stress as a state of mental unease or pressure triggered by challenging circumstances [8].
The scientific literature has demonstrated the impact and multiple negative consequences of stress in the physical and psychological areas of individuals. In the psychological domain, anxiety disorders, depression, and memory and cognitive impairment are among the most prevalent conditions [4,9]. In terms of physical manifestations, irritable bowel syndrome, Crohn’s disease, cardiovascular diseases, hypertension, type 2 diabetes, asthma, rheumatoid arthritis, chronic pain, accelerated biological aging, and premature mortality are among the conditions that have been linked to stress [4,9,10].
Spiritual well-being, in addition to physical, emotional, and social well-being, are among the four most important factors influencing health [11]. Ellison [12] defines spiritual well-being as the sense of inner harmony that each individual has about their relationship with God or a higher self and the relationship they manifest with themselves. In this context, Paloutzian and Ellison [13] determined that the construct of spiritual wellbeing is composed of two underlying factors: religious wellbeing and existential well-being. Religious well-being (vertical) is defined as an individual’s perceived relationship with a higher power (e.g., God); and existential well-being (horizontal) is expressed in the form of purpose, meaning in life, and satisfaction with life, but without any overtly religious elements [12,14]. It is also important to highlight that spiritual wellbeing is situated within the context of research pertaining to the positive psychology of religion and spirituality [14].
Research has shown that there are multiple factors related to the presence of stress; these include sociodemographic aspects (sex, age, household income, education and occupation); health behaviors (tobacco use, alcohol consumption, physical inactivity, dietary intake, and weight change); psychosocial environment (marital status, living alone, employment status, shift work, working hours, weight change, body mass index, perceived body image, and skipping meals), clinical diseases (pulmonary diseases, asthma, hypertension, diabetes mellitus, dementia, mental disability, cancer, and degenerative diseases) and psychological diseases (depression, anxiety, among others) [15,16]. Nevertheless, spiritual well-being plays a pivotal role in the experience of stress [17-23].
The Lazarus and Folkman model conceptualizes stress as a dynamic interaction between the individual and the environment. Stress arises when environmental demands surpass the individual’s personal resources to manage them [24]. The process begins with cognitive appraisal, which involves primary appraisal (assessing the threat) and secondary appraisal (evaluating resources and options). Coping strategies are categorized into two types: problem-focused coping (altering the stressful situation) and emotion-focused coping (managing the associated emotions). Emotion-focused strategies include tactics to manage negative emotions, such as seeking social support, positive reappraisal, relaxation techniques, among others. In this context, it can be inferred that spiritual well-being (understood as an individual’s relationship with oneself and with God) functions as an emotion-focused coping strategy. Therefore, according to the model proposed by these authors, it can be concluded that spiritual well-being is related to stress [25].
Multiple studies have revealed the relationship between spiritual well-being and stress [17-23]. For example, in a study conducted with African-American evangelical pastors, it was found that those with higher levels of spiritual well-being experienced fewer stress symptoms, highlighting the importance of spirituality in mitigating stress within this specific group [26]. Similarly, a study involving evangelical Christian women demonstrated a strong negative correlation between spiritual wellbeing and stress, suggesting that spirituality may serve as a protective factor against stress in these communities [27]. Moreover, the relationship between spiritual well-being and stress is not confined to Christian communities. A study conducted among members of Muslim communities also showed a significant correlation between these two variables. Participants with higher levels of spiritual well-being reported lower levels of stress, suggesting that, regardless of specific religious affiliation, spirituality plays a crucial role in stress reduction [28]. This relationship has been observed across a variety of contexts and demographic groups, suggesting that spiritual well-being may be a universally relevant factor in promoting mental health. For example, correlations between these two constructs have been demonstrated in patients with chronic diseases [29], in patients in intensive care units [30], and in a population without a particular religious denomination [31].
The religious landscape in Peru is predominantly Christian, with approximately 76% of the population identifying as Christian, reflecting the strong presence of this religion in the country [32]. Although other religions are present, such as Islam (5%) and other minority faiths, Christianity remains the predominant religion [32]. The distinctiveness of Christianity in Peru lies in its deep integration with local culture and traditions [33]. Peruvian Christianity, particularly in its evangelical variant, is characterized by a strong sense of community and active religious practice, including participation in regular worship services, bible studies, and mutual support activities within the congregation [34,35]. These aspects could significantly influence the relationship between spiritual well-being and stress, as community cohesion and a sense of belonging, common in Peruvian Christian communities, can provide emotional and psychological support, thereby mitigating the effects of stress [36]. Additionally, religiosity in Peru is often intertwined with a sense of purpose and meaning in life, both of which have been identified as protective factors against stress [37]. This unique cultural and religious context makes the exploration of spiritual wellbeing within the Peruvian Christian population particularly relevant for understanding how these factors may influence mental health in this region.
Despite the high prevalence of Christianity and the importance of spirituality in the lives of Peruvians, no prior studies have explored the relationship between spiritual well-being and stress in this specific context. Most of the existing research on spiritual well-being and stress has been conducted in other cultural and religious contexts, predominantly in Western countries, and has demonstrated that spirituality can serve as a protective factor against stress. However, this research does not capture the unique dynamics present in Peru, where religiosity is deeply integrated with local customs and where the Christian faith may manifest in ways that differ significantly from other contexts. For example, in Peruvian Christian communities, active participation in church, mutual support within congregations, and daily religious practices are key factors that could influence how stress is experienced and managed. The general objective of this research was to determine the relationship between spiritual well-being and stress among members of a Christian community in southern Peru. Additionally, the specific objectives were: 1) to describe and compare spiritual well-being and stress by sex, 2) to determine the correlation between spiritual well-being and stress, 3) to conduct a predictive analysis of stress, and 4) to examine the moderating role of sex in the relationship between spiritual wellbeing and stress.
METHODS
Design
The research adopted a quantitative approach with a nonexperimental, cross-sectional, explanatory design [38]. This design was selected to analyze the influence of the independent variables (spiritual well-being and sex) on the dependent variable (stress).
Sample
The sample consisted of 250 members from four churches and five congregations of the Seventh-day Adventist Christian denomination, located in the province of Ilo, Moquegua, Peru. Data collection occurred between June and December 2023. The instruments were administered face-to-face, with a time frame of 5 to 7 minutes per person. Participants’ responses were anonymous and voluntary, and all participation was subject to informed consent.
The sample was selected using non-probability purposive sampling [38]. Using the statistical program G*Power 3.1.9.7, it was determined that a sample of 107 individuals would be sufficient to detect effects with an α=0.05, a power of 0.95, a moderate effect size (f2=0.15), and two predictors [39]. However, a larger sample size was considered for this study (n=250).
The sociodemographic characteristics of the sample are presented below. The research participants (n=250) had a mean age of 40.68 years (standard deviation [SD]=13.44), with an almost equal distribution between female (51.6%) and male (48.4%). The majority of participants have a basic level of education (59.6%) and are married (56.0%). In terms of employment, self-employed workers predominate (66.0%), followed by dependent employees (27.2%) and a minority who are unemployed (6.8%). Regarding the time since baptism, most participants have been baptized for more than 5 years (76.0%), while the remaining (24.0%) have been baptized for less than 5 years (Table 1).
Instruments
Sociodemographic data
The sociodemographic information sheet included the following indicators: sex, age, level of education, place of local origin, marital status, employment status, and time of baptism.
Spiritual Well-Being Scale
The Spiritual Well-Being Scale (SWBS) was developed at the University of Idaho [13]. The SWBS comprises 20 items and employs a 5-point Likert-type scale. The score for the spiritual well-being variable is in the range of 100. Higher scores represent greater spiritual well-being. It was adapted to the Peruvian context by Rafael Chauca et al. [40] The authors demonstrated that the SWBS is a reliable instrument in the Peruvian context, with an alpha coefficient of 0.836. Furthermore, Diaz Chavarri and Cornejo Flores [41] demonstrated the instrument’s reliability in Peru, with an internal consistency index of 0.850, as measured by Cronbach’s alpha coefficient for the general scale. The reliability results for the spiritual well-being instrument in this study show high overall reliability, with a Cronbach’s alpha of 0.889 and a McDonald’s ω coefficient of 0.894. For the specific dimensions, Cronbach’s alpha is 0.815 for the Religious factor and 0.856 for the Existential factor, with McDonald’s ω coefficients of 0.831 and 0.858, respectively. In addition, confirmatory factor analysis (CFA) validated the instrument’s structure, showing significant standardized factor loadings (p<0.001) ranging from 0.485 to 0.729. Measures of model fit, including a comparative fit index (CFI) of 0.894, Tucker-Lewis Index (TLI) of 0.881, standardized root mean square residual (SRMR) of 0.0617, and root mean square error of approximation (RMSEA) of 0.0623, suggest a good fit, confirming the instrument’s validity for measuring spiritual well-being.
Stress Scale
The Stress Scale (SS-7) was developed by Lovibond and Lovibond [42]. This instrument is part of a battery of instruments that assess anxiety, depression, and stress (Depression, Anxiety, and Stress Scale-21). The instrument is unidimensional and consists of seven items. Each item is answered according to the presence and intensity of each symptom in the last week on a Likert-type response scale of 0 to 3 points. The scale score is calculated by adding the scores of the items that belong to that scale and ranges from 0 to 21 points. The SS-7 was adapted to the Peruvian context in people over 18 years of age by Tapullima and Chávez [43]. The results of the CFA indicated that the model was consistent. The following values were obtained: CFI=0.936, TLI=0.922, RMSEA=0.054, and SRMR=0.047. Furthermore, the scale is invariant in sex and age, with a CFI (ΔCFI<0.01) and RMSEA (ΔRMSEA>0.01) that meet the minimum standards, and a reliability of 0.79. Therefore, the scale presents adequate psychometric properties to be used in Peru. The scale assesses persistent nonspecific activation, difficulty relaxing, irritability, and impatience. The reliability results for the stress instrument in this study show high overall reliability, with a Cronbach’s alpha of 0.827 and a McDonald’s ω coefficient of 0.828. CFA validated the instrument’s structure, showing significant standardized factor loadings (p< 0.001) ranging from 0.516 to 0.723. Measures of model fit, including a CFI of 0.989, TLI of 0.983, SRMR of 0.0278, and RMSEA of 0.0393, suggest an excellent fit, confirming the instrument’s validity for measuring stress.
Ethical aspects
This study was evaluated and approved by the research ethics committee of the Faculty of Health Sciences of the Universidad Peruana Unión (N°: 2023-CE-FCS-UPeU-024). Furthermore, the study adheres to the ethical standards set forth in the Declaration of Helsinki. The instruments were administered in person and the participants’ responses were anonymous.
Statistical analysis
The data obtained were then processed and analyzed using SPSS statistical software, version 29 (IBM Corp.). The psychometric analysis of the instruments was conducted using CFA. The descriptive analysis was then conducted using the mean (M) and SD. Inferential analysis was performed using Pearson’s correlation coefficient, Student’s t test, multiple linear regression, moderation analysis, and d de Cohen.
RESULTS
The following section presents the results of the statistical analysis. In the descriptive analysis, it was found that males report higher levels of spiritual well-being (M=87.17, SD=10.30) and existential well-being (M=42.10, SD=6.38) compared to females (M=85.78, SD=9.28 and M=40.53, SD=6.30, respectively). In terms of religious well-being, females have a slightly higher mean (M=45.25, SD=4.05) than males (M=45.07, SD=5.08). Regarding stress, females report higher levels (M=8.22, SD=3.58) compared to males (M=7.17, SD=3.33). On the other hand, the comparative analysis revealed no statistically significant differences between males and females in spiritual wellbeing (t=1.11, p=0.267, d=0.142) or in religious well-being (t=-0.31, p=0.756, d=0.039), both with small effect sizes. However, there is a marginally significant difference in existential well-being, with males reporting higher well-being than females (t=1.95, p=0.052, d=0.248), with a small to moderate effect size. Regarding stress, females report significantly higher levels than males (t=-2.41, p=0.017, d=0.304), with a moderate effect size (Table 2).
The correlation analysis revealed a negative and statistically significant correlation between spiritual well-being (r=-0.520, p<0.001), religious well-being (r=-0.301, p<0.001), and existential well-being (r=-0.583, p<0.001) with stress, with large, medium, and large effect sizes, respectively. This suggests that higher levels of well-being in these areas are associated with lower levels of stress (Table 3).
In the multiple regression analysis, model 2 (in contrast to model 1) was found to be statistically significant overall (adjusted R2=0.278, F=48.967, p<0.001), as well as in the individual coefficients (p<0.001). The results of model 2 reveal that both spiritual well-being (β=-0.512, p<0.001) and sex (β=0.114, p=0.035) are significant predictors of stress, with spiritual well-being being the variable with the greatest impact. Spiritual well-being has a significant negative effect on stress reduction, while being female is associated with slightly higher stress levels compared to males. Together, these two variables (spiritual well-being and sex) explain 27.8% of the variability in stress levels (adjusted R2=0.278) (Table 4).
Regarding the moderation analysis, the interaction between spiritual well-being and sex was found to be non-significant (b=-0.0303, SE=0.0405, t=-0.7469, p=0.456). This indicates that the relationship between spiritual well-being and stress does not vary significantly by sex. In other words, the effect of spiritual well-being on stress is similar for both sexes (Table 5).
In summary, females report higher stress levels (M=8.22, SD=3.58) than males (M=7.17, SD=3.33), with statistically significant results (t=-2.41, p=0.017, d=0.304). Likewise, a negative and statistically significant correlation was found between spiritual well-being (r=-0.520, p<0.001), religious well-being (r=-0.301, p<0.001), and existential well-being (r=-0.583, p< 0.001) with stress. Multiple regression indicated that spiritual well-being and sex predict 27.8% of the variability in stress (adjusted R2=0.278). Spiritual well-being (β=-0.512, p<0.001) has a significant negative effect on stress reduction, while being female (β=0.114, p=0.035) is associated with higher stress levels compared to males. The moderation effect was not significant, suggesting that spiritual well-being affects stress equally in both sexes (b=-0.0303, standard error=0.0405, t=-0.7469, p=0.456).
DISCUSSION
Stress is an important public health problem, contributing to the development of numerous psychological and physical disorders, including anxiety disorders, depression, memory and cognitive impairment, irritable bowel syndrome, Crohn’s disease, cardiovascular disease, hypertension, type 2 diabetes, asthma, rheumatoid arthritis, chronic pain, accelerated biological aging, and premature mortality [4,9,10]. On the other hand, spiritual well-being is considered a variable that has a positive impact on stress [19,29,44]. Therefore, the purpose of this research was to determine the relationship between spiritual well-being and stress among members of a Christian community in southern Peru.
The results of this study demonstrated a correlation between spiritual well-being and stress in members of a Christian community. In other words, the study showed that spiritual well-being plays a role in reducing stress levels. These results are consistent with a study conducted in members of Muslim communities [28]. Similar outcomes were also observed in another study conducted with black evangelical pastors and evangelical Christian women [26,27]. Similarly, studies conducted during the context of the COVID-19 pandemic and in traumatic contexts (e.g., natural disasters) demonstrated the relationship between spiritual well-being and resilience, respectively, with mental health [45,46]. The associations between spiritual wellbeing and stress are also consistent with other studies conducted in patients with chronic diseases and in intensive care units [29,30]. Similar results were also observed in a population without a particular religious affiliation and in samples of university students [31,47-50].
In the Peruvian context, several cultural factors may influence the relationship between spiritual well-being and stress. Peru is a country with rich cultural diversity, where religious beliefs, particularly Christian ones, are deeply embedded in people’s daily lives [37]. Religiosity in Peru is not only manifested through practices such as church attendance and prayer, but is also deeply intertwined with traditional festivities, community rituals, and a strong sense of social support within congregations [33]. These cultural factors could enhance the effect of spiritual well-being as a resilience mechanism against stress and other mental illnesses in general [35]. Additionally, the influence of extended family and community in the lives of individuals is particularly strong in Peruvian culture, which can amplify the positive impact of spiritual well-being by providing a robust support network [51,52]. Therefore, it is essential to consider these cultural dynamics when interpreting the results of this study and when designing interventions aimed at improving mental health through spirituality in Peruvian communities.
The results of the predictive analysis indicate that spiritual well-being predicts 27.9% of the variability of stress. This means that individuals with a higher level of spiritual wellbeing (an adequate relationship with a higher self and with themselves) are less likely to experience stress. These findings align with the results of previous research that indicate a positive correlation between spiritual well-being and a reduced incidence of stress and anxiety [26,28]. Previous studies indicate that spiritual practices, such as meditation, prayer, and participation in religious or spiritual communities, can be effective tools to manage stressful situations and improve psychological resilience [53,54]. In addition, spiritual well-being is associated with greater perceived social support and purpose in life [55], factors that mitigate the adverse effects of stress [56]. This link may be explained, in part, by the ability of these spiritual/religious practices to foster inner reflection, provide a sense of community and connection, and promote positive emotions, which strengthens overall mental health [57]. It is therefore recommended that approaches that promote spiritual well-being be integrated into stress prevention and management programs. This would help to highlight the importance of addressing spiritual components as part of a holistic strategy to improve health and well-being. Further research into the manner in which spiritual well-being affects stress could also improve psychological and public health interventions designed to mitigate stress in a variety of populations.
Furthermore, the results indicate that sex is a significant predictor of stress. The findings demonstrate that women have higher stress scores than men. The results of this study align with those of previous research that has identified sex-based differences in stress experiences and manifestations [58,59]. It has been suggested that these discrepancies may be attributable to biological factors, such as the hormonal response to stress, and psychosocial factors, including traditional sex roles and social expectations that can intensify the pressures experienced by women [60,61]. Furthermore, research has shown that women tend to report higher levels of stress due to their greater likelihood of facing multiple roles simultaneously, such as work and family responsibilities [62]. It is also possible that women are more likely to recognize and report their experiences of stress, which may reflect differences in emotional socialization between sex. These observations underscore the need to address sex differences in stress management interventions; they also suggest the importance of designing specific strategies that take into account these variabilities. For example, support programs that focus on women’s particular stress management needs could be especially beneficial. This approach would not only enhance the efficacy of stress interventions but also facilitate a more comprehensive understanding of the intrinsic factors that shape the way individuals perceive stress in diverse sociocultural settings.
Public health implications
The findings on spiritual well-being and sex differences in relation to stress have profound implications for public health, suggesting the need to incorporate spiritual and sex-sensitive strategies into mental health programs. Incorporating spiritual elements, such as meditation and mindfulness, into stress management initiatives could positively impact mental health at the community level by aligning these practices with the beliefs of diverse population groups. It is also essential to design targeted interventions that address specific factors that contribute to stress in women, such as programs that focus on work-life balance and support for working mothers. In religious communities, such as Christian communities in Peru, religious leaders and congregations can use these findings to develop programs that integrate spiritual elements, such as community prayer, meditation, and faith-based social support, as mechanisms for managing stress. These interventions can be aligned with local religious beliefs and practices, maximizing their effectiveness by being deeply rooted in the community’s culture. Additionally, expanding education and awareness of stress would allow individuals and communities to develop better strategies for stress management. The results underscore the need for further research to elucidate the causal relationships and mechanisms linking lifestyle factors to stress; this, in turn, can inform the development of public policies that promote healthier work and social environments. These policies could include the promotion of spiritual practices in the workplace and the adaptation of flexible work schedules. These strategies would contribute significantly to the overall health and well-being of the population. These results suggest that interventions integrating spiritual components may be particularly effective in regions sharing sociocultural characteristics with Peru, including other Latin American countries and developing regions. Thus, the study not only contributes to local knowledge but also offers valuable insights that can be applied globally to improve well-being and reduce stress in communities facing similar challenges.
Limitations and future research
The results of this study indicate a significant relationship between spiritual well-being and stress in members of a Christian community in Peru. However, it is important to consider the limitations of the study when interpreting the findings. For example, it is important to recognize that these findings can vary according to the specific characteristics of other populations and contexts. An additional limitation is the use of a nonprobabilistic sample selection method, which restricts the ability to generalize the results to larger populations. Furthermore, the cross-sectional design of the study excludes the ability to establish causal relationships between the variables under investigation. For future research, it would be beneficial to explore the relationship between spiritual well-being and stress by incorporating additional variables that may influence this dynamic, such as hope, faith, psychological well-being, and happiness. This approach would facilitate a more comprehensive understanding of the interrelationships between various aspects of emotional and spiritual well-being. It is also recommended that further research be conducted in other religious, social, and cultural contexts to determine whether the trends observed in this study are consistent between different groups and settings. A more comprehensive examination of these relationships would not only improve our understanding of them, but would also facilitate the development of more effective and culturally tailored stress management interventions for diverse communities.
Conclusions
The findings of this study highlight a clear relationship between spiritual well-being and stress, underscoring how a higher level of spiritual well-being is associated with lower levels of stress. Additionally, multiple regression analysis revealed that spiritual well-being and sex are significant predictors of stress. Specifically, it was found that females tend to experience higher levels of stress compared to males. These findings not only contribute to our understanding of the factors that influence stress, but also highlight the importance of considering spiritual and sex dimensions in stress management strategies; in addition, they may be relevant to developing interventions to alleviate stress in various demographic groups, especially females.
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