Associations Between Intrinsic Religiosity, Mental Health, and Quality of Life in a Christian Community

Associations Between Intrinsic Religiosity, Mental Health, and Quality of Life in a Christian Community | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Associations Between Intrinsic Religiosity, Mental Health, and Quality of Life in a Christian Community Rejane Célia de Souza Godinho, Paulo Silva Godinho, Lanny Cristina Burlandy Soares, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8809260/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This cross-sectional study examined the associations between intrinsic religiosity, symptoms of depression, anxiety and stress, and overall quality of life in members of a high religious/spiritual Christian community in the northern region of Brazil during the first months of the COVID-19 pandemic. The sample consisted of 1,053 participants (78.06% without chronic disease; 57.83% reported good quality of life). Data were collected in 2020 using an online questionnaire that included sociodemographic information, the Duke Religion Index (DUREL), the Depression, Anxiety and Stress Scale (DASS-21) and the WHOQOL-BREF. Statistical analyses were conducted in R (version 4.4.1) and RStudio, using Confirmatory Factor Analysis, Structural Equation Modeling (SEM) with Weighted Least Squares Mean and Variance adjusted estimation, McDonald's omega and Composite Reliability indices. The SEM indicated that intrinsic religiosity was negatively associated with depression (β = -0.530, p = .030) and stress (β = -0.797, p = .010), and positively associated with anxiety (β = 0.979, p < .001). Overall quality of life was positively associated with intrinsic religiosity (β = 0.284, p < .001). Age, gender and income did not significantly influence quality of life. The findings suggest that intrinsic religiosity plays a multifaceted role in mental health and quality of life, presenting both protective and ambivalent associations. The results highlight the complexity of religiosity as a psychological resource in a Brazilian Christian context and reinforce the need for longitudinal studies to clarify these relationships. Psychology Religious Studies intrinsic religiosity mental health quality of life structural equation modeling Figures Figure 1 Introduction The relationship between religiosity (R), mental health (MH), and quality of life (Qol) is multifaceted, encompassing both positive and negative associations. While most studies have relied on correlational approaches to identify these links, such methods do not explain the mechanisms underlying them. Structural Equation Modeling (SEM) allows us to test competing associative models, estimating direct and indirect statistical paths between intrinsic religiosity, mental health symptoms, and quality of life. In a cross-sectional design, however, SEM does not establish mechanisms or causality; instead, it identifies which associative patterns are most compatible with the observed data. Variations in how psychology conceptualizes religiosity, spirituality and mental health reflect the diversity of conclusions about their association (Hackney & Sanders, 2003). In this study, religiosity/spirituality is understood as the degree to which an individual believes, follows, and practices a religion, expressed in intrinsic religiosity (religion as central to life) forms (Koenig, 2012). Mental health is defined as a state of well-being that enables individuals to recognize their abilities, manage daily stress, and contribute to their community (World Health Organization, 2022). Within this framework, stress and depression are conceptualized according to the DASS-21 (Vignola & Tucci, 2014), which characterizes stress as an emotional state arising from the appraisal of situations as threatening or challenging, and depression as an emotional disorder without a specific dominant emotion. Current Study Integrating a religious/spiritual approach that enhances faith and promotes mental health and the quality of life for those who have higher spirituality can help to improve adherence, treatment acceptance, and patient collaboration. In this context, we accomplished a cross-sectional study with highly religious people that had participated in a spiritual formation process that began in 2018 and finished in 2020, during the first wave of COVID-19. Specially, we hypothesized that (1) there is positive and negative relation between intrinsic religiosity and mental health (Koenig, 2012), (2) religiosity is positively and negatively associated with quality of life (Panzini et al., 2017), and (3) intrinsic religiosity may have direct and indirect effects in the relationship between mental health and quality of life. The aim of this study is to investigate how intrinsic religiosity relates to symptoms of depression, anxiety, stress and quality of life in a sample of a high religious/spiritual Christian community in northern Brazil. Methods Participants This cross-sectional study was conducted with members of a highly religious/spiritual Christian community who had previously participated in spiritual formation organized by the North Para Conference of Seventh-Day Adventist Church. The program promoted holistic health (physical, mental, spiritual, and social) through practices such as prayer, fasting, Bible reading, healthy lifestyle habits, and trust in God. It reached about 50,000 people and 500 congregations in diverse regions, supported by written, oral, and audiovisual communication, peer motivation, and continuous leader training. The program was not interrupted during the lockdown in COVID-19 pandemic but continued with transmissions online and shared content on social media (Facebook, YouTube, WhatsApp, Instagram). Data was collected only from individuals who participated in at least one of the four editions of spiritual formation. A key limitation was low internet access. The study was approved by the Institutional Review Board of Adventist University of São Paulo (UNASP), CEP protocol number: 5.493.466. Of the 1,077 online questionnaires returned, 24 were incomplete and excluded, resulting in a final sample of 1,053 participants (M = 39.7 years, SD = 11.1), above 18 years that voluntarily provided informed consent. Sample Procedures A minimum target of 500 participants was established to provide adequate power (.80) to detect small-to-moderate effects (Cohen’s d ≈ 0.20; r ≈ 0.10) at α = .05. The final sample consisted of 1,053 participants exceeding this requirement. This larger sample enhanced the precision of parameter estimates and reduced the likelihood of Type II errors. No masking procedures were used, as data was obtained through self-report questionnaires in a cross-sectional design. The mean age was 39.68 years (SD = 11.14), mostly female (64.01%). In terms of race, most identified as mixed-race (71.13%), followed by White (14.81%), Black (11.97%), Asian (0.19%), and Indigenous (0.85%). The majority were married (74.55%), 18.90% were single, and 75.78% had children; widowed, divorced, and separated participants together accounted for less than 10%. Educational levels varied, with most having completed high school (35.04%), followed by higher education (24.22%) and postgraduate studies (18.04%). Regarding income, 29.34% reported earning up to one minimum wage, 24.69% up to half a minimum wage, and only 1.80% more than 10 minimum wages. Most participants were baptized (99.24%), with a mean of 14.99 years since baptism (SD = 11.52) (See Table 1). Data was collected online via SurveyMonkey between June and September 2020 after participants provided electronic informed consent. Primary measures included religiosity/spirituality, assessed with the Duke Religious Index (Koenig et al., 1997; Lucchetti et al., 2012); mental health, assessed with the Depression, Anxiety, and Stress Scale (Lovibond, 1995; Vignola & Tucci, 2014); and quality of life, assessed with the WHOQOL-BREF (Fleck et al., 2000; Whoqol Group, 1998). Sociodemographic covariates included age, sex, marital status, education, race/ethnicity, and household income, with socioeconomic status measured using the ABEP/ABIPEME validated questionnaire (Associação Brasileira de Empresas de Pesquisa, 2016). All instruments used have demonstrated adequate reliability in Brazilian samples. Confirmatory factor analysis (CFA) was performed as a preliminary step to evaluate the adequacy of the measurement model before estimating the full structural equation modeling (SEM) analysis (Hoyle, 2012). The model demonstrated good fit, with χ²(186) = 502.73, χ²/df = 2.69, p < .001, CFI = .98, TLI = .97, RMSEA = .06 (90% CI [.06, .07]), and SRMR = .04. Participants with incomplete or inconsistent responses were excluded. Because all items were mandatory in the online survey, no missing data or imputations were required. Outliers were screened, and data distributions were examined for normality; all variables met assumptions for SEM with WLSMV estimation. No data transformations were necessary. Results Preliminary Analyses Confirmatory Factor Analysis (CFA) was used to assess the adjustments of the instruments to the sample and then to test the relationships between the variables in the structural model (Structural Equation Modeling - SEM). Estimation was carried out using the Weighted Least Squares Mean-and-Variance adjusted (WLSMV) method, which is suitable for ordinal data (Li, 2016; Muthén & Muthén, 2012). The fit indices considered were: χ², χ²/gl, Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Standardized Root Mean Residual (SRMR) and Root Mean Square Error of Approximation (RMSEA). The criteria adopted were: χ²/gl < 5 (preferably < 3); CFI and TLI ≥ .95; RMSEA < .08 (ideally < .06) with an upper limit of the confidence interval .70, and by Average Variance Extracted (AVE), with values > .50 (Raykov, 1997). The analyses were carried out in the R software (version 4.4.1) and RStudio (2024.09.0+375), using the lavaan 0.6-19 package (Rosseel, 2012). Confirmatory Factor Analysis The factor model of the DASS-21 scale showed adequate fit indices [χ² (186) = 502.725, χ²/gl = 2.69; p 0.50), and the factors showed adequate reliability indices. The three-factor model of DUREL, proposed by Koenig and Büssing (2010), could not be tested, because the first two factors have only one item each, making the model non-identifiable. A two-factor model was tested using the dimensions “Religious Activity” and “Intrinsic Religiosity” (Toscanelli et al., 2022), but items 1 and 2 showed very low factor loadings (Durel 1: 0.23 and Durel 2: 0.08), indicating that is not suitable for this sample. The unidimensional model resulted in overfitting indices [χ² (3) = 1335; p < 0.001; CFI = 1.0; TLI = 1.0; RMSEA = .0, SRMR = .0]. As it was a simple model (one-dimensional, with three indicators), there was a perfect fit to the data. Although the introduction of additional degrees of freedom could, in theory, improve the identification of the model, this procedure is not recommended as it implies the artificial addition of parameters (Hoyle, 2012). Therefore, in this study, we opted to use only the Intrinsic Religiosity factor, whose indicators showed consistent factor loadings and adequate reliability indices. The three items that form the intrinsic religiosity factor showed robust factor loadings (>0.50), and the factor showed adequate reliability indices. The factor model of the WHOQOL-Bref scale showed adequate fit indices [χ² (203) = 523.668, χ²/gl = 2.5; p < 0.001; CFI = .98; TLI = .98; RMSEA = .069, CI 90% (.062, .076); SRMR = .064]. In the WHOQOL scale, only item 15 showed a low factor loading, while all others loaded robustly (≈ 0.50). Since this item did not compromise overall model fit, it was retained for score computation. The AVE values for the Social and Environmental factors were slightly below expectations; specifically, the Environmental factor showed good internal consistency but a low AVE (0.36), suggesting insufficient variance capture for this sample. Correlations Intrinsic Religiosity showed significant but weak negative correlations with Depression (rho = -0.23, p < .001), Anxiety (rho = -0.13, p < .001), and Stress (rho = -0.24, p < .001), suggesting higher religiosity is associated with lower symptom levels. Regarding WHOQOL domains, the Physical domain correlated weakly and negatively with Depression (rho = -0.10, p = .01), Anxiety (rho = -0.07, p = .05), and Stress (rho = -0.11, p < .001). The Psychological domain showed weak negative correlations with Depression (rho = -0.11, p < .001), Anxiety (rho = -0.10, p = .01), and Stress (rho = -0.14, p < .001). The Social domain correlated weakly and negatively only with Stress (rho = -0.08, p = .02). Overall WHOQOL scores correlated weakly and negatively with Depression (rho = -0.10, p = .01), Anxiety (rho = -0.08, p = .01), and Stress (rho = -0.12, p < .001). In sum, correlations were statistically significant but of weak magnitude (See Table 1). Structural Equation Modeling – WHOQOL Outcome – Model 1 The model (See Figure 1) showed adequate fit indices for the indicators of each instrument [χ² (317) = 818.655, χ²/gl = 2.58; p < .001; CFI = .98; TLI = .98; RMSEA = .04, IC 90% (.03, .04); SRMR = .04]. A reflective model was specified with three latent DASS-21 dimensions (Anxiety, Depression, Stress), the DUREL scale (Intrinsic Religiosity), and Overall Quality of Life (WHOQOL domains). The WHOQOL Environmental domain was excluded due to low AVE in this sample. The model showed good fit indices [χ² (317) = 818.655, χ²/gl = 2.58; p < .001; CFI = .98; TLI = .98; RMSEA = .04, IC 90% (.03, .04); SRMR = .04]. All latent variables were adequately represented, with standardized factor loading above 0.50 (See Table 2). SEM results showed that Intrinsic Religiosity (IR) was significantly predicted by Depression (β = -0.530, p = .030), Anxiety (β = 0.979, p < .001), and Stress (β = -0.797, p = .010). Higher depression and stress were associated with lower IR, while higher anxiety was linked to greater IR. In turn, IR significantly predicted Overall Quality of Life (β = 0.284, p < .001). The model explained 27% of the variance in IR (R² = 0.27) and 8% of the variance in Overall Quality of Life (R² = 0.08) (See Table 3). Structural Equation Modeling ­ – Control Variables – Model 2 A SEM model including age, sex, and income as control variables was specified to test the mediating power of Intrinsic Religiosity. The model showed good fit indices [χ²(392) = 1090.294, χ²/df = 0.36, p < .001; CFI = .98; TLI = .98; RMSEA = .04, 90% CI (.04–.05); SRMR = .04]. All latent variables were well represented, with standardized loadings above 0.50. SEM analysis showed that Intrinsic Religiosity (IR) was significantly predicted by Depression (β = -0.494, p = .033), Anxiety (β = 0.905, p < .001), and Stress (β = -0.696, p = .014). Higher depression and stress were associated with lower IR, while higher anxiety predicted greater IR. However, IR did not significantly predict Overall Quality of Life (β = -0.034, p = .568), and Depression, Anxiety, and Stress also showed no direct effects on Quality of Life. Control variables (age, sex, income) exerted some influence but were not statistically significant. The model explained 21% of the variance in IR (R² = 0.21) and 4% in Overall Quality of Life (R² = 0.04) (See Table 4). For Depression (DEP), the indirect effect on Overall Quality of Life via Intrinsic Religiosity (IR) was negative and non-significant (β = -0.017, p = .594), and the total effect was also non-significant (β = 0.080, p = .690), indicating no direct or mediated impact. For Anxiety (ANS), both the indirect effect through IR (β = 0.031, p = .567) and the total effect (β = 0.215, p = .243) were non-significant. For Stress (EST), the indirect effect was non-significant (β = -0.024, p = .563), and the total effect was negative but also non-significant (β = -0.425, p = .066) (See Table 5). Overall, results show that in this sample, Depression, Anxiety, and Stress neither exerted significant direct effects on Quality of Life nor indirect effects mediated by IR. Discussion During the COVID-19 pandemic, studies reported high rates of anxiety (6.33–50.9%), depression (14.6–48.3%), PTSD (7–53.8%), psychological distress (34.43–38%), and stress (8.1–81.9%) across multiple countries, with risk factors including female gender, younger age (≤40), chronic or psychiatric conditions, unemployment, student status, and frequent exposure to pandemic-related media (Xiong et al., 2020). However, findings on the role of religiousness during the pandemic were mixed. Cross-cultural evidence indicated that its relationship with distress and well-being is complex and context-dependent, showing associations with lower, higher, or no levels of distress (David et al., 2023). The results of this study were mixed. Both positive and negative associations between intrinsic religiosity and mental health were found, as we hypothesized, and a significant but weak negative correlation was found between intrinsic religiosity and symptoms of depression, anxiety, and stress. This suggests that higher religiosity was linked to lower levels of these symptoms during the first year of COVID-19, following participation in spiritual formation. Similarly, research in Colombia and South Africa indicated that when hope was low, well-being was higher among individuals who engaged in positive religious coping, using faith as a constructive resource (Captari et al., 2022). In line with this, Salopek-Žiha et al. (2020) also reported that religiousness was associated with lower distress during first year of COVID-19. This finding is consistent with previous research in no COVID context, with vulnerable population living in Pantanal Wetlands, Brazil (Gonçalves et al., 2018), elderly populations in Brazil (Abdala et al., 2015) and older people around the world (Coelho-Júnior et al., 2022). On the other hand, Porto et al. (2022) found no significant correlation between intrinsic religiosity and mental health in a Brazilian adult sample (M = 27.97 years). SEM analysis in our study revealed that higher levels of depression and stress were associated with lower intrinsic religiosity (IR), while higher anxiety predicted greater IR. This pattern highlights the nuanced ways in which different dimensions of mental health may relate to religious involvement. Koenig et al. (2024) called attention to findings contradicting Freud (1962) description that religion is motivated by human anxiety and fear. In a review of 299 quantitative studies on religiosity and anxiety, 49% reported lower anxiety among more religious individuals, 11% found a positive association, and 40% reported no significant relationship. According to Freud, higher anxiety should be linked to higher religiosity Our study found that IR significantly predicted Overall Quality of Life in Brazilians adults. It is in accordance with previous research, where IR were associated with more psychological quality of life in Brazilian adults (Peres et al., 2018). Higher levels of spirituality and religiosity (S/R) were associated with better health-related quality of life among healthy adults (Borges et al., 2021), and religiosity was positively associated with college students’ quality of life during COVID-19 (Joseph et al., 2023). No associations were found between IR and QoL domains in young adults nursing students from Greece, India, Kenya, and United States of America (Felicilda-Reynaldo et al., 2019). Our findings did not show direct and indirect effects of religiosity on mental health and Qol as hypothesized. The analysis revealed that depression, anxiety, and stress did not exert significant direct or indirect effects on overall quality of life, and the intrinsic religiosity did not modify the relationship between these mental health variables and quality of life. One possible explanation lies in the characteristics of the sample. Most participants were classified as normal regarding depression (71.13%), with only 6.27% presenting mild symptoms, 3.42% moderate, and 0.47% severe depression. Similarly, 84.81% reported normal levels of anxiety, while 6.08% were at a moderate level, 1.90% severe, and 0.57% extremely severe. Stress levels were predominantly normal (94.51%), with few cases of mild (3.70%) and moderate stress (0.76%). Regarding quality of life, the majority rated it as Good (57.83%) or Very Good (15.10%), with only 2.28% reporting Low levels, and 78.06% reported no chronic diseases. These results in symptoms of depression, anxiety and stress were lower than those presented by Xiong et al. (2020). Another possible explanation is the ceiling effect, which reduces variability in the data and weakens the strength of the observed relationships. And other factors, possibly contextual or individual, may also be influencing the effects of depression, anxiety and stress. Generaliability In line with previous research using the DUREL scale and Koenig’s definitions of religiosity and spirituality, our sample reported high levels of spirituality and intrinsic religiosity. These findings are consistent with studies showing that higher intrinsic religiosity (IR) is more prevalent among women than men and among students living in rural compared to urban settings (Felicilda-Reynaldo et al., 2019). Cross-cultural research with nursing students in Greece, the United States, India, and Kenya also indicated moderate levels of intrinsic religiosity (Cruz et al., 2018). Moreover, prior studies with vulnerable populations in Brazil demonstrated that greater spirituality was associated with lower anxiety and depressive symptoms, while higher IR specifically predicted fewer depressive symptoms (β = -0.315, p < 0.001) (Gonçalves et al., 2018). However, consistent with our findings, these authors did not observe a significant association between religiosity/spirituality and overall quality of life in a vulnerable population in Pantanal Wetlands. Taken together, these comparisons suggest that while religiosity and spirituality are protective against symptoms of depression and anxiety across diverse populations, their relationship with quality of life remains less consistent in people with higher R/S due the factors explained above. Implications Future research should investigate whether other factors such as religious coping, flourishing, no chronic illness, low and moderate symptoms (of depression, anxiety and stress), wellbeing, spiritual fight, frustration, personal beliefs etc. simultaneously play a significant role in preventing anxiety and depression, as well as examine potential moderators of this relationship among highly religious individuals in the general population. In clinical practice, incorporating a spiritual history at the initial assessment has been recommended for managing depression, anxiety, and other emotional problems (Koenig et al., 2020). Evidence further suggests that including spiritual history and interventions can support the management of emotional problems, foster trust and adherence, and enhance mental health and quality of life, although additional research is still required, particularly in Brazil (Galvão et al., 2025; Panzini et al., 2017; Peres et al., 2018). In addition, religious patients can have anxiety reduced by simple religious practices aligned with his/her own faith as prayer, religious writing, attending services, meditation, volunteering, mantra repetition or scripture reading (Gonçalves et al., 2015; Gonçalves et., 2018; Razali, 1998; Rosmarin et al., 2010). Pastoral care or religious group counseling may benefit individuals with milder anxiety, including that related to medical settings (Hosseini et al., 2013; Koenig, 2024). Despite these benefits, religion and spirituality remain underutilized in clinical contexts due to limited awareness, insufficient training, ideological barriers, and institutional tensions. These challenges highlight the urgent need for healthcare systems to integrate religious and spiritual approaches in an evidence-based, culturally sensitive, and patient-centered manner (Moreira-Almeida et al., 2014). Limitation This study presents several limitations. First, it is cross-sectional and focused on a specific high religious/spiritual Christian community within the general population, with data collected online exclusively from individuals who had previously participated in a spiritual intervention, which restricts the generalizability of the findings. Another limitation is the scarcity of community-based studies involving non-patient populations, particularly in Brazil, where religiosity and spirituality are culturally significant yet understudied in relation to depression, anxiety, stress, and quality of life. Moreover, most existing non-patient research in this field has been conducted with medical and nursing students, who are often hypothesized to display reduced levels of religiosity due to the influence of university education (Beit-Hallahmi, 2015). In addition, participants were not assessed before and after the spiritual formation program, limiting conclusions about changes over time. A methodological limitation may also involve a ceiling effect, as instruments may not have been sensitive enough to capture higher levels of functioning. Finally, although randomized controlled trials (RCTs) support the hypothesis that religious involvement can reduce anxiety, evidence remains mixed (Koenig, 2024). Therefore, future RCTs are needed to examine the effects of religiosity and spirituality on quality of life and symptoms of depression, anxiety, and stress in the general population. The results highlight the complexity of religiosity as a psychological resource in a Brazilian Christian context and reinforce the need for longitudinal studies to clarify these relationships. References Abdala, G. A., Kimura, M., Duarte, Y. A. de O., Lebrão, M. L., & Santos, B. dos. (2015). Religiousness and health-related quality of life of older adults. Revista de Saúde Pública , 49 (0). https://doi.org/10.1590/s0034-8910.2015049005416 Associação Brasileira de Empresas de Pesquisa. (2016). 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Religion index for psychiatric research. The American journal of psychiatry , 154 (6), 885–886. https://doi.org/10.1176/ajp.154.6.885b Li, C. H. (2016). The performance of ML, DWLS, and ULS estimation with robust corrections in structural equation models with ordinal variables . Psychological methods , 21(3), 369–387. https://doi.org/10.1037/met0000093 Lovibond, S. H., & Lovibond, P. F. (1995). Depression Anxiety Stress Scales (DASS--21, DASS--42) [Database record]. APA PsycTests. https://doi.org/10.1037/t01004-000 Lucchetti, G., Granero Lucchetti, A. L., Peres, M. F., Leão, F. C., Moreira-Almeida, A., & Koenig, H. G. (2012). Validation of the Duke Religion Index: DUREL (Portuguese Version). Journal of Religion and Health , 51 (2), 579-586. https://doi.org/10.1007/s10943-010-9429-5 ‌Moreira-Almeida, A., Koenig, H. G., & Lucchetti, G. (2014). Clinical implications of spirituality to mental health: review of evidence and practical guidelines. 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(1997). Estimation of composite reliability for congeneric measures. Applied Psychological Measurement, 21 (2), 173–184. https://doi.org/10.1177/01466216970212006 Razali, S. M., Hasanah, C. I., Aminah, K., & Subramaniam, M. (1998). Religious--sociocultural psychotherapy in patients with anxiety and depression. The Australian and New Zealand Journal of Psychiatry , 32 (6), 867-872. https://doi.org/10.3109/00048679809073877 Rosmarin, D. H., Pargament, K. I., Pirutinsky, S., & Mahoney, A. (2010). A randomized controlled evaluation of a spiritually integrated treatment for subclinical anxiety in the Jewish community, delivered via the Internet. Journal of Anxiety Disorders , 24 (7), 799-808. https://doi.org/10.1016/j.janxdis.2010.05.014 Rosseel, Y. (2012). lavaan: An R Package for Structural Equation Modeling. Journal of Statistical Software , 48 (2), 1–36. https://doi.org/10.18637/jss.v048.i02 Salopek-Žiha, D., Hlavati, M., Gvozdanović, Z., Gašić, M., Placento, H., Jakić, H., Klapan, D., & Šimić, H. (2020). Differences in Distress and Coping with the COVID-19 Stressor in Nurses and Physicians. Psychiatria Danubina , 32 (2), 287–293. https://doi.org/10.24869/psyd.2020.287 Toscanelli, C., Shino, E., Robinson, S. L., & Thalmayer, A. G. (2022). Religiousness worldwide: translation of the Duke University Religion Index into 20 languages and validation across 27 nations. Measurement Instruments for the Social Sciences , 4 (1). https://doi.org/10.1186/s42409-022-00041-2 Vignola, R. C., & Tucci, A. M. (2014). Adaptation and validation of the depression, anxiety and stress scale (DASS) to Brazilian Portuguese. Journal of affective disorders , 155 , 104–109. https://doi.org/10.1016/j.jad.2013.10.031 World Health Organization. (2022, June 17). Mental health . World Health Organization. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response Whoqol Group. (1998). Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychological Medicine , 28 (3), 551-558. https://doi.org/10.1017/s0033291798006667 Xiong, J., Lipsitz, O., Nasri, F., Lui, L. M. W., Gill, H., Phan, L., Chen-Li, D., Iacobucci, M., Ho, R., Majeed, A., & McIntyre, R. S. (2020). Impact of COVID-19 pandemic on mental health in the general population: A systematic review. Journal of affective disorders , 277 , 55–64. https://doi.org/10.1016/j.jad.2020.08.00 Tables Table 1 Spearman correlations between scale scores rho p Intrinsic Religiosity WHOQOL Physical 0.02 0.62 Intrinsic Religiosity WHOQOL Psychological 0.05 0.12 Intrinsic Religiosity WHOQOL Social 0.05 0.14 Intrinsic Religiosity WHOQOL Environmental 0.00 0.81 Intrinsic Religiosity WHOQOL Total 0.04 0.15 Intrinsic Religiosity Depression -0.23 < .001 Intrinsic Religiosity Anxiety -0.13 < .001 Intrinsic Religiosity Stress -0.24 < .001 WHOQOL Physical Depression -0.10 0.01 WHOQOL Physical Anxiety -0.07 0.05 WHOQOL Physical Stress -0.11 < .001 WHOQOL Psychological Depression -0.11 < .001 WHOQOL Psychological Anxiety -0.10 0.01 WHOQOL Psychological Stress -0.14 < .001 WHOQOL Social Depression -0.05 0.12 WHOQOL Social Anxiety -0.05 0.12 WHOQOL Social Stress -0.08 0.02 WHOQOL Environmental Depression -0.05 0.13 WHOQOL Environmental Anxiety -0.04 0.22 WHOQOL Environmental Stress -0.05 0.15 WHOQOL Total Depression -0.10 0.01 WHOQOL Total Anxiety -0.08 0.01 WHOQOL Total Stress -0.12 < .001 Table 2 Factor loadings for each of the latent variable indicators in the model Latent/Indicator Non-standardized EP z p Standardized Depression DASS 3 1.000 0.000 0.673 DASS 5 1.083 0.044 24.780 0.000 0.729 DASS 10 1.197 0.047 25.369 0.000 0.806 DASS 13 1.323 0.052 25.606 0.000 0.891 DASS 16 1.278 0.051 25.169 0.000 0.860 DASS 17 1.271 0.050 25.384 0.000 0.856 DASS 21 1.316 0.053 25.024 0.000 0.886 Anxiety DASS 2 1.000 0.637 DASS 4 1.125 0.048 23.622 0.000 0.716 DASS 7 1.214 0.054 22.381 0.000 0.773 DASS 9 1.321 0.055 24.173 0.000 0.842 DASS 15 1.406 0.060 23.551 0.000 0.896 DASS 19 1.285 0.058 22.271 0.000 0.818 DASS 20 1.336 0.058 23.130 0.000 0.851 Stress DASS 1 1.000 0.645 DASS 6 1.130 0.050 22.709 0.000 0.729 DASS 8 1.368 0.052 26.427 0.000 0.882 DASS 11 1.319 0.051 25.766 0.000 0.851 DASS 12 1.286 0.049 26.217 0.000 0.830 DASS 14 1.238 0.046 26.805 0.000 0.799 DASS 18 1.225 0.053 23.307 0.000 0.790 Intrinsic Religiosity Durel 3 1.000 0.700 Durel 4 1.155 0.133 8.673 0.000 0.809 Durel 5 1.023 0.130 7.867 0.000 0.716 Quality of Life General WHOQOL Physical 1.000 0.659 WHOQOL Psychological 1.623 0.184 8.796 0.000 0.883 WHOQOL Social 1.389 0.147 9.457 0.000 0.637 Table 3 Structural Equation Modeling (SEM) regression coefficients Regression Non-standardized EP Z p β IR <- DEP -0.544 0.250 -2.173 0.030 -0.530 ANX 1.061 0.274 3.878 0.000 0.979 STR -0.850 0.331 -2.568 0.010 -0.797 GQV <- IR 3.220 0.885 3.637 0.000 0.284 Note. Depression (DEP), Anxiety (ANX) Stress (STR), Intrinsic Religiosity (IR) and General Quality of Life (GQV). Table 4 Structural Equation Modeling (SEM) regression coefficients controlled for age, gender and income Regression Non-standardized EP z P Β IR <- DEP -0.514 0.241 -2.129 0.033 -0.494 ANX 0.994 0.250 3.981 0.000 0.905 STR -0.755 0.308 -2.454 0.014 -0.696 GQV <- IR 0.404 0.707 0.571 0.568 0.034 DEP 1.192 2.540 0.469 0.639 0.097 ANX 2.389 2.682 0.891 0.373 0.184 STR -5.128 3.062 -1.675 0.094 -0.401 Age 0.063 0.032 2.014 0.044 0.083 Sex 0.831 0.689 1.206 0.228 0.048 Income 0.045 0.180 0.253 0.800 0.010 Note. Depression (DEP), Anxiety (ANX) Stress (STR), Intrinsic Religiosity (IR) and General Quality of Life (GQV). Table 5 Indirect and Total Effects Effects Non-standardi-zed EP z p β DEP (indirect) -0.207 0.389 -0.533 0.594 -0.017 DEP (total effect) 0.985 2.466 0.399 0.690 0.080 ANX (indirect effect) 0.401 0.701 0.573 0.567 0.031 ANX (total effect) 2.790 2.388 1.169 0.243 0.215 STR (indirect effect) -0.305 0.527 -0.579 0.563 -0.024 STR (total effect) -5.433 2.956 -1.838 0.066 -0.425 Note. Depression (DEP), Anxiety (ANX) and Stress (STR). Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8809260","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587134214,"identity":"8797bf17-e291-400d-bfd1-9cdb353626d4","order_by":0,"name":"Rejane Célia de Souza Godinho","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-6207-588X","institution":"Federal University of Pará","correspondingAuthor":true,"prefix":"","firstName":"Rejane","middleName":"Célia de Souza","lastName":"Godinho","suffix":""},{"id":587134215,"identity":"50181fa5-a70e-4d7b-bd3a-12ee4b4f5c85","order_by":1,"name":"Paulo Silva Godinho","email":"","orcid":"https://orcid.org/0009-0008-2462-8771","institution":"São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Paulo","middleName":"Silva","lastName":"Godinho","suffix":""},{"id":587134216,"identity":"f268a87a-1bd3-4ca1-80ed-64289ee29b8e","order_by":2,"name":"Lanny Cristina Burlandy Soares","email":"","orcid":"https://orcid.org/0000-0003-0037-2069","institution":"Adventist University Center of São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Lanny","middleName":"Cristina Burlandy","lastName":"Soares","suffix":""},{"id":587134217,"identity":"6d7e6cd2-2490-4a99-a4bd-f7e811705bf4","order_by":3,"name":"Amauri Gouveia Jr","email":"","orcid":"https://orcid.org/0000-0003-1710-9662","institution":"Federal University of Pará","correspondingAuthor":false,"prefix":"","firstName":"Amauri","middleName":"","lastName":"Gouveia","suffix":"Jr"},{"id":587134218,"identity":"10e3a285-140e-420d-a845-bd6056339a5c","order_by":4,"name":"Janari da Silva Pedroso","email":"","orcid":"https://orcid.org/0000-0001-7602-834X","institution":"Federal University of Pará","correspondingAuthor":false,"prefix":"","firstName":"Janari","middleName":"da Silva","lastName":"Pedroso","suffix":""}],"badges":[],"createdAt":"2026-02-06 16:27:26","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8809260/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8809260/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102316131,"identity":"ddf1216a-454f-46a6-bcbd-db8973cf1aa9","added_by":"auto","created_at":"2026-02-10 12:42:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":199924,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eGraphical representation of Structural Equation Modeling (SEM)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8809260/v1/39bbe15f81a0a0e6cc2bd23c.png"},{"id":102316226,"identity":"1fdd00c8-f305-4bd1-b478-d186e2318abc","added_by":"auto","created_at":"2026-02-10 12:43:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1082737,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8809260/v1/b3ae7a8a-c71d-4dd4-bb16-c57cc982bfd7.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eAssociations Between Intrinsic Religiosity, Mental Health, and Quality of Life in a Christian Community\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe relationship between religiosity (R), mental health (MH), and quality of life (Qol) is multifaceted, encompassing both positive and negative associations. While most studies have relied on correlational approaches to identify these links, such methods do not explain the mechanisms underlying them. Structural Equation Modeling\u0026nbsp;(SEM) allows us to test competing associative models, estimating direct and indirect statistical paths between intrinsic religiosity, mental health symptoms, and quality of life. In a cross-sectional design, however, SEM does not establish mechanisms or causality; instead, it identifies which associative patterns are most compatible with the observed data.\u003c/p\u003e\n\u003cp\u003eVariations in how psychology conceptualizes religiosity, spirituality and mental health reflect the diversity of conclusions about their association (Hackney \u0026amp; Sanders, 2003). In this study, religiosity/spirituality is understood as the degree to which an individual believes, follows, and practices a religion, expressed in intrinsic religiosity (religion as central to life) forms (Koenig, 2012). Mental health is defined as a state of well-being that enables individuals to recognize their abilities, manage daily stress, and contribute to their community (World Health Organization, 2022). Within this framework, stress and depression are conceptualized according to the DASS-21 (Vignola \u0026amp; Tucci, 2014), which characterizes stress as an emotional state arising from the appraisal of situations as threatening or challenging, and depression as an emotional disorder without a specific dominant emotion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCurrent Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntegrating a religious/spiritual approach that enhances faith and promotes mental health and the quality of life for those who have higher spirituality can help to improve adherence, treatment acceptance, and patient collaboration. In this context, we accomplished a cross-sectional study with highly religious people that had participated in a spiritual formation process that began in 2018 and finished in 2020, during the first wave of COVID-19.\u003c/p\u003e\n\u003cp\u003eSpecially, we hypothesized that (1) there is positive and negative relation between intrinsic religiosity and mental health (Koenig, 2012), (2) religiosity is positively and negatively associated with quality of life (Panzini et al., 2017), and (3) intrinsic religiosity may have direct and indirect effects in the relationship between mental health and quality of life. The aim of this study is to investigate how intrinsic religiosity relates to symptoms of depression, anxiety, stress and quality of life in a sample of a high religious/spiritual Christian community in northern Brazil.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study was conducted with members of a highly religious/spiritual Christian community who had previously participated in spiritual formation organized by the North Para Conference of Seventh-Day Adventist Church. The program promoted holistic health (physical, mental, spiritual, and social) through practices such as prayer, fasting, Bible reading, healthy lifestyle habits, and trust in God. It reached about 50,000 people and 500 congregations in diverse regions, supported by written, oral, and audiovisual communication, peer motivation, and continuous leader training.\u003c/p\u003e\n\u003cp\u003eThe program was not interrupted during the lockdown in COVID-19 pandemic but continued with transmissions online and shared content on social media (Facebook, YouTube, WhatsApp, Instagram). Data was collected only from individuals who participated in at least one of the four editions of spiritual formation. A key limitation was low internet access. The study was approved by the Institutional Review Board of Adventist University of S\u0026atilde;o Paulo (UNASP), CEP protocol number: 5.493.466. Of the 1,077 online questionnaires returned, 24 were incomplete and excluded, resulting in a final sample of 1,053 participants (M = 39.7 years, SD = 11.1), above 18 years that voluntarily provided informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA minimum target of 500 participants was established to provide adequate power (.80) to detect small-to-moderate effects (Cohen\u0026rsquo;s d \u0026asymp; 0.20; r \u0026asymp; 0.10) at \u0026alpha; = .05. The final sample consisted of 1,053 participants exceeding this requirement. This larger sample enhanced the precision of parameter estimates and reduced the likelihood of Type II errors. No masking procedures were used, as data was obtained through self-report questionnaires in a cross-sectional design.\u003c/p\u003e\n\u003cp\u003eThe mean age was 39.68 years (SD = 11.14), mostly female (64.01%). In terms of race, most identified as mixed-race (71.13%), followed by White (14.81%), Black (11.97%), Asian (0.19%), and Indigenous (0.85%). The majority were married (74.55%), 18.90% were single, and 75.78% had children; widowed, divorced, and separated participants together accounted for less than 10%. Educational levels varied, with most having completed high school (35.04%), followed by higher education (24.22%) and postgraduate studies (18.04%). Regarding income, 29.34% reported earning up to one minimum wage, 24.69% up to half a minimum wage, and only 1.80% more than 10 minimum wages. Most participants were baptized (99.24%), with a mean of 14.99 years since baptism (SD = 11.52) (See Table 1).\u003c/p\u003e\n\u003cp\u003eData was collected online via SurveyMonkey between June and September 2020 after participants provided electronic informed consent. Primary measures included religiosity/spirituality, assessed with the Duke Religious Index (Koenig et al., 1997; Lucchetti et al., 2012); mental health, assessed with the Depression, Anxiety, and Stress Scale (Lovibond, 1995; Vignola \u0026amp; Tucci, 2014); and quality of life, assessed with the WHOQOL-BREF (Fleck et al., 2000; Whoqol Group, 1998). Sociodemographic covariates \u0026nbsp;included age, sex, marital status, education, race/ethnicity, and household income, with socioeconomic status measured using the ABEP/ABIPEME validated questionnaire (Associa\u0026ccedil;\u0026atilde;o Brasileira de Empresas de Pesquisa, 2016). All instruments used have demonstrated adequate reliability in Brazilian samples.\u003c/p\u003e\n\u003cp\u003eConfirmatory factor analysis (CFA) was performed as a preliminary step to evaluate the adequacy of the measurement model before estimating the full structural equation modeling (SEM) analysis (Hoyle, 2012). The model demonstrated good fit, with \u0026chi;\u0026sup2;(186) = 502.73, \u0026chi;\u0026sup2;/df = 2.69, p \u0026lt; .001, CFI = .98, TLI = .97, RMSEA = .06 (90% CI [.06, .07]), and SRMR = .04.\u003c/p\u003e\n\u003cp\u003eParticipants with incomplete or inconsistent responses were excluded. Because all items were mandatory in the online survey, no missing data or imputations were required. Outliers were screened, and data distributions were examined for normality; all variables met assumptions for SEM with WLSMV estimation. No data transformations were necessary.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePreliminary Analyses\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConfirmatory Factor Analysis (CFA) was used to assess the adjustments of the instruments to the sample and then to test the relationships between the variables in the structural model (Structural Equation Modeling - SEM). Estimation was carried out using the \u003cem\u003eWeighted Least Squares Mean-and-Variance adjusted\u003c/em\u003e (WLSMV) method, which is suitable for ordinal data (Li, 2016; Muth\u0026eacute;n \u0026amp; Muth\u0026eacute;n, 2012). The fit indices considered were: \u0026chi;\u0026sup2;, \u0026chi;\u0026sup2;/gl, Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Standardized Root Mean Residual (SRMR) and Root Mean Square Error of Approximation (RMSEA). The criteria adopted were: \u0026chi;\u0026sup2;/gl \u0026lt; 5 (preferably \u0026lt; 3); CFI and TLI \u0026ge; .95; RMSEA \u0026lt; .08 (ideally \u0026lt; .06) with an upper limit of the confidence interval \u0026lt; .10 (Brown, 2015). Reliability was assessed by McDonald\u0026apos;s omega and Composite Reliability (CC), considering values \u0026gt; .70, and by Average Variance Extracted (AVE), with values \u0026gt; .50 (Raykov, 1997). The analyses were carried out in the R software (version 4.4.1) and RStudio (2024.09.0+375), using the \u003cem\u003elavaan\u003c/em\u003e 0.6-19 package (Rosseel, 2012).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConfirmatory Factor Analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe factor model of the DASS-21 scale showed adequate fit indices [\u0026chi;\u0026sup2; (186) = 502.725, \u0026chi;\u0026sup2;/gl = 2.69; \u003cem\u003ep\u003c/em\u003e\u0026lt; 0.001; CFI = .98; TLI = .97; RMSEA = .06, CI 90% (.06, .07); SRMR = .04]. The three factor items that constitute the DASS-21 scale showed robust factor loading (\u0026gt;0.50), and the factors showed adequate reliability indices.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe three-factor model of DUREL, proposed by Koenig and B\u0026uuml;ssing (2010), could not be tested, because the first two factors have only one item each, making the model non-identifiable. A two-factor model was tested using the dimensions \u0026ldquo;Religious Activity\u0026rdquo; and \u0026ldquo;Intrinsic Religiosity\u0026rdquo; (Toscanelli et al., 2022), but items 1 and 2 showed very low factor loadings (Durel 1: 0.23 and Durel 2: 0.08), indicating that is not suitable for this sample. The unidimensional model resulted in overfitting indices [\u0026chi;\u0026sup2; (3) = 1335; \u003cem\u003ep\u003c/em\u003e\u0026lt; 0.001; CFI = 1.0; TLI = 1.0; RMSEA = .0, SRMR = .0].\u003c/p\u003e\n\u003cp\u003eAs it was a simple model (one-dimensional, with three indicators), there was a perfect fit to the data. Although the introduction of additional degrees of freedom could, in theory, improve the identification of the model, this procedure is not recommended as it implies the artificial addition of parameters (Hoyle, 2012). Therefore, in this study, we opted to use only the Intrinsic Religiosity factor, whose indicators showed consistent factor loadings and adequate reliability indices. The three items that form the intrinsic religiosity factor showed robust factor loadings (\u0026gt;0.50), and the factor showed adequate reliability indices.\u003c/p\u003e\n\u003cp\u003eThe factor model of the WHOQOL-Bref scale showed adequate fit indices [\u0026chi;\u0026sup2; (203) = 523.668, \u0026chi;\u0026sup2;/gl = 2.5; \u003cem\u003ep\u003c/em\u003e\u0026lt; 0.001; CFI = .98; TLI = .98; RMSEA = .069, CI 90% (.062, .076); SRMR = .064]. In the WHOQOL scale, only item 15 showed a low factor loading, while all others loaded robustly (\u0026asymp; 0.50). Since this item did not compromise overall model fit, it was retained for score computation. The AVE values for the Social and Environmental factors were slightly below expectations; specifically, the Environmental factor showed good internal consistency but a low AVE (0.36), suggesting insufficient variance capture for this sample.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCorrelations\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntrinsic Religiosity showed significant but weak negative correlations with Depression (rho = -0.23, p \u0026lt; .001), Anxiety (rho = -0.13, p \u0026lt; .001), and Stress (rho = -0.24, p \u0026lt; .001), suggesting higher religiosity is associated with lower symptom levels. Regarding WHOQOL domains, the Physical domain correlated weakly and negatively with Depression (rho = -0.10, p = .01), Anxiety (rho = -0.07, p = .05), and Stress (rho = -0.11, p \u0026lt; .001). The Psychological domain showed weak negative correlations with Depression (rho = -0.11, p \u0026lt; .001), Anxiety (rho = -0.10, p = .01), and Stress (rho = -0.14, p \u0026lt; .001). The Social domain correlated weakly and negatively only with Stress (rho = -0.08, p = .02). Overall WHOQOL scores correlated weakly and negatively with Depression (rho = -0.10, p = .01), Anxiety (rho = -0.08, p = .01), and Stress (rho = -0.12, p \u0026lt; .001). In sum, correlations were statistically significant but of weak magnitude (See Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStructural Equation Modeling\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003cstrong\u003e\u0026ndash;\u003c/strong\u003e \u003cstrong\u003eWHOQOL Outcome \u0026ndash; Model 1\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe model (See Figure 1) showed adequate fit indices for the indicators of each instrument [\u0026chi;\u0026sup2; (317) = 818.655, \u0026chi;\u0026sup2;/gl = 2.58; \u003cem\u003ep\u003c/em\u003e\u0026lt; .001; CFI = .98; TLI = .98; RMSEA = .04, IC 90% (.03, .04); SRMR = .04]. A reflective model was specified with three latent DASS-21 dimensions (Anxiety, Depression, Stress), the DUREL scale (Intrinsic Religiosity), and Overall Quality of Life (WHOQOL domains). The WHOQOL Environmental domain was excluded due to low AVE in this sample. The model showed good fit indices [\u0026chi;\u0026sup2; (317) = 818.655, \u0026chi;\u0026sup2;/gl = 2.58; \u003cem\u003ep\u003c/em\u003e\u0026lt; .001; CFI = .98; TLI = .98; RMSEA = .04, IC 90% (.03, .04); SRMR = .04]. All latent variables were adequately represented, with standardized factor loading above 0.50 (See Table 2).\u003c/p\u003e\n\u003cp\u003eSEM results showed that Intrinsic Religiosity (IR) was significantly predicted by Depression (\u0026beta; = -0.530, p = .030), Anxiety (\u0026beta; = 0.979, p \u0026lt; .001), and Stress (\u0026beta; = -0.797, p = .010). Higher depression and stress were associated with lower IR, while higher anxiety was linked to greater IR. In turn, IR significantly predicted Overall Quality of Life (\u0026beta; = 0.284, p \u0026lt; .001). The model explained 27% of the variance in IR (R\u0026sup2; = 0.27) and 8% of the variance in Overall Quality of Life (R\u0026sup2; = 0.08) (See Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStructural Equation Modeling\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u0026shy; \u003cstrong\u003e\u0026ndash;\u003c/strong\u003e \u003cstrong\u003eControl Variables \u0026ndash; Model 2\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA SEM model including age, sex, and income as control variables was specified to test the mediating power of Intrinsic Religiosity. The model showed good fit indices [\u0026chi;\u0026sup2;(392) = 1090.294, \u0026chi;\u0026sup2;/df = 0.36, p \u0026lt; .001; CFI = .98; TLI = .98; RMSEA = .04, 90% CI (.04\u0026ndash;.05); SRMR = .04]. All latent variables were well represented, with standardized loadings above 0.50.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSEM analysis showed that Intrinsic Religiosity (IR) was significantly predicted by Depression (\u0026beta; = -0.494, p = .033), Anxiety (\u0026beta; = 0.905, p \u0026lt; .001), and Stress (\u0026beta; = -0.696, p = .014). Higher depression and stress were associated with lower IR, while higher anxiety predicted greater IR. However, IR did not significantly predict Overall Quality of Life (\u0026beta; = -0.034, p = .568), and Depression, Anxiety, and Stress also showed no direct effects on Quality of Life. Control variables (age, sex, income) exerted some influence but were not statistically significant. The model explained 21% of the variance in IR (R\u0026sup2; = 0.21) and 4% in Overall Quality of Life (R\u0026sup2; = 0.04) (See Table 4).\u003c/p\u003e\n\u003cp\u003eFor Depression (DEP), the indirect effect on Overall Quality of Life via Intrinsic Religiosity (IR) was negative and non-significant (\u0026beta; = -0.017, p = .594), and the total effect was also non-significant (\u0026beta; = 0.080, p = .690), indicating no direct or mediated impact. For Anxiety (ANS), both the indirect effect through IR (\u0026beta; = 0.031, p = .567) and the total effect (\u0026beta; = 0.215, p = .243) were non-significant. For Stress (EST), the indirect effect was non-significant (\u0026beta; = -0.024, p = .563), and the total effect was negative but also non-significant (\u0026beta; = -0.425, p = .066) (See Table 5). Overall, results show that in this sample, Depression, Anxiety, and Stress neither exerted significant direct effects on Quality of Life nor indirect effects mediated by IR.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDuring the COVID-19 pandemic, studies reported high rates of anxiety (6.33\u0026ndash;50.9%), depression (14.6\u0026ndash;48.3%), PTSD (7\u0026ndash;53.8%), psychological distress (34.43\u0026ndash;38%), and stress (8.1\u0026ndash;81.9%) across multiple countries, with risk factors including female gender, younger age (\u0026le;40), chronic or psychiatric conditions, unemployment, student status, and frequent exposure to pandemic-related media (Xiong et al., 2020). However, findings on the role of religiousness during the pandemic were mixed. Cross-cultural evidence indicated that its relationship with distress and well-being is complex and context-dependent, showing associations with lower, higher, or no levels of distress (David et al., 2023).\u003c/p\u003e\n\u003cp\u003eThe results of this study were mixed. Both positive and negative associations between intrinsic religiosity and mental health were found, as we hypothesized, and a significant but weak negative correlation was found between intrinsic religiosity and symptoms of depression, anxiety, and stress. This suggests that higher religiosity was linked to lower levels of these symptoms during the first year of COVID-19, following participation in spiritual formation. Similarly, research in Colombia and South Africa indicated that when hope was low, well-being was higher among individuals who engaged in positive religious coping, using faith as a constructive resource (Captari et al., 2022). In line with this, Salopek-Žiha et al. (2020) also reported that religiousness was associated with lower distress during first year of COVID-19.\u003c/p\u003e\n\u003cp\u003eThis finding is consistent with previous research in no COVID context, with vulnerable population living in Pantanal Wetlands, Brazil (Gon\u0026ccedil;alves et al., 2018), elderly populations in Brazil (Abdala et al., 2015) and older people around the world (Coelho-J\u0026uacute;nior et al., 2022). On the other hand, Porto et al. (2022) found no significant correlation between intrinsic religiosity and mental health in a Brazilian adult sample (M = 27.97 years).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSEM analysis in our study revealed that higher levels of depression and stress were associated with lower intrinsic religiosity (IR), while higher anxiety predicted greater IR. This pattern highlights the nuanced ways in which different dimensions of mental health may relate to religious involvement.\u003c/p\u003e\n\u003cp\u003eKoenig et al. (2024) called attention to findings contradicting Freud (1962) description that religion is motivated by human anxiety and fear. In a review of 299 quantitative studies on religiosity and anxiety, 49% reported lower anxiety among more religious individuals, 11% found a positive association, and 40% reported no significant relationship. According to Freud, higher anxiety should be linked to higher religiosity\u003c/p\u003e\n\u003cp\u003eOur study found that IR significantly predicted Overall Quality of Life in Brazilians adults. It is in accordance with previous research, where IR were associated with more psychological quality of life in Brazilian adults (Peres et al., 2018). Higher levels of spirituality and religiosity (S/R) were associated with better health-related quality of life among healthy adults (Borges et al., 2021), and religiosity was positively associated with college students\u0026rsquo; quality of life during COVID-19 (Joseph et al., 2023). No associations were found between IR and QoL domains in young adults nursing students from Greece, India, Kenya, and United States of America\u0026nbsp;(Felicilda-Reynaldo et al., 2019).\u003c/p\u003e\n\u003cp\u003eOur findings did not show direct and indirect effects of religiosity on mental health and Qol as hypothesized. The analysis revealed that depression, anxiety, and stress did not exert significant direct or indirect effects on overall quality of life, and the intrinsic religiosity did not modify the relationship between these mental health variables and quality of life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne possible explanation lies in the characteristics of the sample. Most participants were classified as normal regarding depression (71.13%), with only 6.27% presenting mild symptoms, 3.42% moderate, and 0.47% severe depression. Similarly, 84.81% reported normal levels of anxiety, while 6.08% were at a moderate level, 1.90% severe, and 0.57% extremely severe. Stress levels were predominantly normal (94.51%), with few cases of mild (3.70%) and moderate stress (0.76%). Regarding quality of life, the majority rated it as Good (57.83%) or Very Good (15.10%), with only 2.28% reporting Low levels, and 78.06% reported no chronic diseases. These results in symptoms of depression, anxiety and stress were lower than those presented by Xiong et al. (2020).\u003c/p\u003e\n\u003cp\u003eAnother possible explanation is the ceiling effect, which reduces variability in the data and weakens the strength of the observed relationships. And other factors, possibly contextual or individual, may also be influencing the effects of depression, anxiety and stress.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eGeneraliability\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn line with previous research using the DUREL scale and Koenig\u0026rsquo;s definitions of religiosity and spirituality, our sample reported high levels of spirituality and intrinsic religiosity. These findings are consistent with studies showing that higher intrinsic religiosity (IR) is more prevalent among women than men and among students living in rural compared to urban settings (Felicilda-Reynaldo et al., 2019). Cross-cultural research with nursing students in Greece, the United States, India, and Kenya also indicated moderate levels of intrinsic religiosity (Cruz et al., 2018). Moreover, prior studies with vulnerable populations in Brazil demonstrated that greater spirituality was associated with lower anxiety and depressive symptoms, while higher IR specifically predicted fewer depressive symptoms (\u0026beta; = -0.315, p \u0026lt; 0.001) (Gon\u0026ccedil;alves et al., 2018). However, consistent with our findings, these authors did not observe a significant association between religiosity/spirituality and overall quality of life in a vulnerable population in Pantanal Wetlands. Taken together, these comparisons suggest that while religiosity and spirituality are protective against symptoms of depression and anxiety across diverse populations, their relationship with quality of life remains less consistent in people with higher R/S due the factors explained above.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eImplications\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFuture research should investigate whether other factors such as religious coping, flourishing, no chronic illness, low and moderate symptoms (of depression, anxiety and stress), wellbeing, spiritual fight, frustration, personal beliefs etc. simultaneously play a significant role in preventing anxiety and depression, as well as examine potential moderators of this relationship among highly religious individuals in the general population. In clinical practice, incorporating a spiritual history at the initial assessment has been recommended for managing depression, anxiety, and other emotional problems (Koenig et al., 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEvidence further suggests that including spiritual history and interventions can support the management of emotional problems, foster trust and adherence, and enhance mental health and quality of life, although additional research is still required, particularly in Brazil (Galv\u0026atilde;o et al., 2025; Panzini et al., 2017; Peres et al., 2018). In addition, religious patients can have anxiety reduced by simple religious practices aligned with his/her own faith as prayer, religious writing, attending services, meditation, volunteering, mantra repetition or scripture reading (Gon\u0026ccedil;alves et al., 2015; Gon\u0026ccedil;alves et., 2018; Razali, 1998; Rosmarin et al., 2010). Pastoral care or religious group counseling may benefit individuals with milder anxiety, including that related to medical settings (Hosseini et al., 2013; Koenig, 2024). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite these benefits, religion and spirituality remain underutilized in clinical contexts due to limited awareness, insufficient training, ideological barriers, and institutional tensions. These challenges highlight the urgent need for healthcare systems to integrate religious and spiritual approaches in an evidence-based, culturally sensitive, and patient-centered manner (Moreira-Almeida et al., 2014).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLimitation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study presents several limitations. First, it is cross-sectional and focused on a specific high religious/spiritual Christian community within the general population, with data collected online exclusively from individuals who had previously participated in a spiritual intervention, which restricts the generalizability of the findings. Another limitation is the scarcity of community-based studies involving non-patient populations, particularly in Brazil, where religiosity and spirituality are culturally significant yet understudied in relation to depression, anxiety, stress, and quality of life. Moreover, most existing non-patient research in this field has been conducted with medical and nursing students, who are often hypothesized to display reduced levels of religiosity due to the influence of university education (Beit-Hallahmi, 2015). In addition, participants were not assessed before and after the spiritual formation program, limiting conclusions about changes over time. A methodological limitation may also involve a ceiling effect, as instruments may not have been sensitive enough to capture higher levels of functioning. Finally, although randomized controlled trials (RCTs) support the hypothesis that religious involvement can reduce anxiety, evidence remains mixed (Koenig, 2024). Therefore, future RCTs are needed to examine the effects of religiosity and spirituality on quality of life and symptoms of depression, anxiety, and stress in the general population. The results highlight the complexity of religiosity as a psychological resource in a Brazilian Christian context and reinforce the need for longitudinal studies to clarify these relationships.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbdala, G. A., Kimura, M., Duarte, Y. A. de O., Lebr\u0026atilde;o, M. L., \u0026amp; Santos, B. dos. (2015). Religiousness and health-related quality of life of older adults. \u003cem\u003eRevista de Sa\u0026uacute;de P\u0026uacute;blica\u003c/em\u003e, \u003cem\u003e49\u003c/em\u003e(0). https://doi.org/10.1590/s0034-8910.2015049005416\u003c/li\u003e\n\u003cli\u003eAssocia\u0026ccedil;\u0026atilde;o Brasileira de Empresas de Pesquisa. (2016).\u003cem\u003e Crit\u0026eacute;rio de Classifica\u0026ccedil;\u0026atilde;o Econ\u0026ocirc;mica Brasil.\u003c/em\u003e http://www.abep.org/criterio-brasil\u003c/li\u003e\n\u003cli\u003eBeit-Hallahmi, B. (2015). Explaining the Secularity of Academics: Historical Questions and Psychological Findings. \u003cem\u003eScience, Religion and Culture\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e(3), 104\u0026ndash;119. https://doi.org/10.17582/journal.src/2015/2.3.104.119\u003c/li\u003e\n\u003cli\u003eBorges, C. C., Santos, P. R. dos, Alves, P. M., Borges, R. C. M., Lucchetti, G., Barbosa, M. A., Porto, C. C., \u0026amp; Fernandes, M. R. (2021). Association between spirituality/religiousness and quality of life among healthy adults: a systematic review. \u003cem\u003eHealth and Quality of Life Outcomes\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(1), 1\u0026ndash;13. https://doi.org/10.1186/s12955-021-01878-7\u003c/li\u003e\n\u003cli\u003eBrown, T. A. (2015). \u003cem\u003eConfirmatory factor analysis for applied research\u003c/em\u003e (2nd ed.). The Guilford Press.\u003c/li\u003e\n\u003cli\u003eCaptari, L. E., Cowden, R. G., Sandage, S. J., Davis, E. B., Bechara, A. O., Joynt, S., \u0026amp; Counted, V. (2022). Religious/spiritual struggles and depression during COVID-19 pandemic lockdowns in the global south: Evidence of moderation by positive religious coping and hope. \u003cem\u003ePsychology of Religion and Spirituality\u003c/em\u003e. https://doi.org/10.1037/rel0000474\u003c/li\u003e\n\u003cli\u003eCoelho-J\u0026uacute;nior, H. J., Calvani, R., Panza, F., Allegri, R. F., Picca, A., Marzetti, E., \u0026amp; Alves, V. P. (2022). Religiosity/Spirituality and Mental Health in Older Adults: A Systematic Review and Meta-Analysis of Observational Studies. \u003cem\u003eFrontiers in Medicine\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e, 877213. https://doi.org/10.3389/fmed.2022.877213\u003c/li\u003e\n\u003cli\u003eCruz, J. P., Felicilda-Reynaldo, R. F. D., Lam, S. C., Machuca Contreras, F. A., John Cecily, H. S., Papathanasiou, I. V., Fouly, H. A., Kamau, S. M., Valdez, G. F. D., Adams, K. A., \u0026amp; Colet, P. C. (2018). Quality of life of nursing students from nine countries: A cross-sectional study. \u003cem\u003eNurse education today\u003c/em\u003e, \u003cem\u003e66\u003c/em\u003e, 135\u0026ndash;142. https://doi.org/10.1016/j.nedt.2018.04.016\u003c/li\u003e\n\u003cli\u003eDavid, A. B., Park, C. L., Awao, S., Vega, S., Zuckerman, M. S., White, T. F., \u0026amp; Hanna, D. (2023). 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Aplica\u0026ccedil;\u0026atilde;o da vers\u0026atilde;o em portugu\u0026ecirc;s do instrumento abreviado de avalia\u0026ccedil;\u0026atilde;o da qualidade de vida \u0026ldquo;WHOQOL-bref.\u0026rdquo; \u003cem\u003eRevista de Sa\u0026uacute;de P\u0026uacute;blica\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e(2), 178\u0026ndash;183. https://doi.org/10.1590/s0034-89102000000200012\u003c/li\u003e\n\u003cli\u003eFreud, S. (1962). \u003cem\u003eThe future os an ilusion\u003c/em\u003e (J. Strachey, Ed.). Hogarth Press. https://ia801304.us.archive.org/28/items/sigmund-freud-the-future-of-an-illusion/sigmund-freud-the-future-of-an-illusion.pdf\u003c/li\u003e\n\u003cli\u003eGalv\u0026atilde;o, L. L., Sulivan, A., Andre, C., Andrade, M. S., Weiss, K., Beat Knechtle, Juliana, B., Gentil, P., Rosemann, T., \u0026amp; Vancini, R. L. (2025). 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Spirituality, Religiosity, Quality of Life and Mental Health Among Pantaneiros: A Study Involving a Vulnerable Population in Pantanal Wetlands, Brazil. \u003cem\u003eJournal of Religion and Health\u003c/em\u003e, \u003cem\u003e57\u003c/em\u003e(6), 2431\u0026ndash;2443. https://doi.org/10.1007/s10943-018-0681-4\u003c/li\u003e\n\u003cli\u003eHackney, C. H., \u0026amp; Sanders, G. S. (2003). Religiosity and Mental Health: A Meta-Analysis of Recent Studies. \u003cem\u003eJournal for the Scientific Study of Religion\u003c/em\u003e, \u003cem\u003e42\u003c/em\u003e(1), 43\u0026ndash;55. https://doi.org/10.1111/1468-5906.t01-1-00160\u003c/li\u003e\n\u003cli\u003eHosseini, M., Salehi, A., Fallahi Khoshknab, M., Rokofian, A., \u0026amp; Davidson, P. M. (2013). 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Association between religiosity, satisfaction with life and mental health: a study of Brazilian adults. \u003cem\u003eDebates in Psychiatry\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e, 1\u0026ndash;16. https://doi.org/10.25118/2763-9037.2022.v12.450\u003c/li\u003e\n\u003cli\u003eRaykov, T. (1997). Estimation of composite reliability for congeneric measures. \u003cem\u003eApplied Psychological Measurement, 21\u003c/em\u003e(2), 173\u0026ndash;184. https://doi.org/10.1177/01466216970212006 \u003c/li\u003e\n\u003cli\u003eRazali, S. M., Hasanah, C. I., Aminah, K., \u0026amp; Subramaniam, M. (1998). Religious--sociocultural psychotherapy in patients with anxiety and depression. \u003cem\u003eThe Australian and New Zealand Journal of Psychiatry\u003c/em\u003e, \u003cem\u003e32\u003c/em\u003e(6), 867-872. https://doi.org/10.3109/00048679809073877\u003c/li\u003e\n\u003cli\u003eRosmarin, D. H., Pargament, K. I., Pirutinsky, S., \u0026amp; Mahoney, A. (2010). 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Impact of COVID-19 pandemic on mental health in the general population: A systematic review. \u003cem\u003eJournal of affective disorders\u003c/em\u003e, \u003cem\u003e277\u003c/em\u003e, 55\u0026ndash;64. https://doi.org/10.1016/j.jad.2020.08.00\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e\u003cem\u003eSpearman correlations between scale scores\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003erho\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIntrinsic Religiosity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWHOQOL Physical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIntrinsic Religiosity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWHOQOL Psychological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIntrinsic Religiosity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWHOQOL Social\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIntrinsic Religiosity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWHOQOL Environmental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIntrinsic Religiosity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWHOQOL Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIntrinsic Religiosity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e-0.23\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026nbsp;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIntrinsic Religiosity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e-0.13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026nbsp;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIntrinsic Religiosity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e-0.24\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026nbsp;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Physical\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e-0.10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Physical\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e-0.07\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Physical\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e-0.11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026nbsp;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Psychological\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e-0.11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026nbsp;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Psychological\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e-0.10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Psychological\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e-0.14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026nbsp;.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWHOQOL Social\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWHOQOL Social\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWHOQOL Social\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eStress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWHOQOL Environmental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWHOQOL Environmental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWHOQOL Environmental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eStress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e-0.10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e-0.08\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e-0.12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; .001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003e\u003cem\u003eFactor loadings for each of the latent variable indicators in the model\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"536\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eLatent/Indicator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eNon-standardized\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eEP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003ez\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eStandardized\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.673\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e24.780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e25.369\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.806\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e25.606\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.891\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e25.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.860\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e25.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.856\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e25.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.886\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e23.622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.716\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e22.381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.773\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e24.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.842\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e23.551\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.896\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e22.271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.818\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e23.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.851\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eStress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.645\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e22.709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e26.427\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.882\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e25.766\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.851\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e26.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.830\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e26.805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.799\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDASS 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e23.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.790\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eIntrinsic Religiosity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDurel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.700\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDurel 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e8.673\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eDurel 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e7.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.716\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eQuality of Life General\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eWHOQOL Physical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eWHOQOL Psychological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.623\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e8.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eWHOQOL Social\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e9.457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.637\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003e\u003cem\u003eStructural Equation Modeling (SEM) regression coefficients\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"461\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRegression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003eNon-standardized\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eEP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eIR \u0026lt;-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eDEP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-2.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eANX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3.878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.979\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eSTR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e-0.850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-2.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-0.797\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eGQV \u0026lt;-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eIR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.885\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote.\u0026nbsp;\u003c/em\u003eDepression (DEP), Anxiety (ANX) Stress (STR), Intrinsic Religiosity (IR) and General Quality of Life (GQV).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003e\u003cem\u003eStructural Equation Modeling (SEM) regression coefficients controlled for age, gender and income\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"492\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eRegression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eNon-standardized\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eEP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003ez\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026Beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eIR \u0026lt;-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eDEP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e-0.514\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-2.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eANX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.994\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.905\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eSTR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e-0.755\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-2.454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eGQV \u0026lt;-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eIR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eDEP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2.540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eANX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2.682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.891\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eSTR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e-5.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-1.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.689\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eIncome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote.\u0026nbsp;\u003c/em\u003eDepression (DEP), Anxiety (ANX) Stress (STR), Intrinsic Religiosity (IR) and General Quality of Life (GQV).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u0026nbsp;\u003c/strong\u003e\u003cem\u003eIndirect and Total Effects\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"505\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eEffects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNon-standardi-zed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eEP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003ez\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eDEP (indirect)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-0.533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eDEP (total effect)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.985\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eANX (indirect effect)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eANX (total effect)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.790\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2.388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.215\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eSTR (indirect effect)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eSTR (total effect)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-5.433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2.956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-1.838\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-0.425\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote.\u0026nbsp;\u003c/em\u003eDepression (DEP), Anxiety (ANX) and Stress (STR).\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Federal University of Para","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"intrinsic religiosity, mental health, quality of life, structural equation modeling","lastPublishedDoi":"10.21203/rs.3.rs-8809260/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8809260/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis cross-sectional study examined the associations between intrinsic religiosity, symptoms of depression, anxiety and stress, and overall quality of life in members of a high religious/spiritual Christian community in the northern region of Brazil during the first months of the COVID-19 pandemic. The sample consisted of 1,053 participants (78.06% without chronic disease; 57.83% reported good quality of life). Data were collected in 2020 using an online questionnaire that included sociodemographic information, the Duke Religion Index (DUREL), the Depression, Anxiety and Stress Scale (DASS-21) and the WHOQOL-BREF. Statistical analyses were conducted in R (version 4.4.1) and RStudio, using Confirmatory Factor Analysis, Structural Equation Modeling (SEM) with Weighted Least Squares Mean and Variance adjusted estimation, McDonald's omega and Composite Reliability indices. The SEM indicated that intrinsic religiosity was negatively associated with depression (β = -0.530, p = .030) and stress (β = -0.797, p = .010), and positively associated with anxiety (β = 0.979, p \u0026lt; .001). Overall quality of life was positively associated with intrinsic religiosity (β = 0.284, p \u0026lt; .001). Age, gender and income did not significantly influence quality of life. The findings suggest that intrinsic religiosity plays a multifaceted role in mental health and quality of life, presenting both protective and ambivalent associations. The results highlight the complexity of religiosity as a psychological resource in a Brazilian Christian context and reinforce the need for longitudinal studies to clarify these relationships.\u003c/p\u003e","manuscriptTitle":"Associations Between Intrinsic Religiosity, Mental Health, and Quality of Life in a Christian Community","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-10 12:39:54","doi":"10.21203/rs.3.rs-8809260/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a0bbbb91-3288-4ff1-9d93-60ce08274caa","owner":[],"postedDate":"February 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":62471814,"name":"Psychology"},{"id":62471815,"name":"Religious Studies"}],"tags":[],"updatedAt":"2026-02-10T12:39:54+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-10 12:39:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8809260","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8809260","identity":"rs-8809260","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}