Investigating spiritual well-being and its relationship with health behaviors, depression, and academic achievement in medical students: a structural equation modeling study

OBJECTIVE: Spiritual well-being (SWB) is a key health dimension crucial for quality of life. For university students facing significant academic pressures, SWB may be a vital resource associated with lower depression, healthier behaviors, and higher academic achievement. This study aimed to investigate the complex interrelationships among these variables in medical students. METHODS: This cross-sectional study enrolled 362 students from Khoy University of Medical Sciences via census sampling. The participants had a mean age of 21.67 ± 2.98 years. The majority of participants were female (55.5%) and single (88.7%). Validated self-report questionnaires were used to measure spiritual well-being (Paloutzian SWB scale), health behaviors (Ahmadi Questionnaire), depression (PHQ-9), and academic performance (GPA). Data were analyzed using Structural Equation Modeling (SEM) to test the direct and indirect pathways within the conceptual model. RESULTS: The final structural model demonstrated good fit (χ²/df = 2.34, RMSEA = 0.060, CFI = 0.91). Spiritual well-being had significant direct positive association with all health behaviors: physical activity (β = 0.35, p < 0.001), healthy diet (β = 0.48, p < 0.001), and no smoking (β = 0.58, p < 0.001). SWB also had a significant direct negative association with depression (β=-0.50, p < 0.001). Among health behaviors, only no smoking showed a significant direct association with lower depression (β=-0.18, p = 0.04). Depression showed a significant negative direct association with academic performance (β=-0.35, p = 0.007). Significant indirect effects revealed an association where SWB was related to better academic performance through its association with increased health behaviors and lower depression. CONCLUSION: Spiritual well-being is a significant factor in comprehensive student health, with its associations with healthier behaviors and lower depression being subsequently linked to academic achievement. Integrating spiritual well-being into university support and educational programs is essential, underscoring the need for targeted interventions in this domain.