Cross-Lagged Associations Between Spiritual-Religious Support and Subjective Health Across 23 Societies: Cross-Level Moderation by Healthcare Access and Quality

Abstract The association between spiritual/religious support and subjective health has not been extensively examined, and little is known about whether regional variation in Healthcare Access and Quality moderates this correlation. To address this gap, this study integrates longitudinal data from the Global Flourishing Study with the Global Burden of Disease dataset and applies multilevel models to examine the association between spiritual/religious support and subjective health, as well as the moderating role of Healthcare Access and Quality ( N = 125,019 across two waves, nested within 23 societies). Results indicate positive cross-lagged associations between spiritual/religious support and subjective health. Moreover, in societies with lower Healthcare Access and Quality, baseline spiritual/religious support may be more strongly associated with subsequent subjective health. These cross-societal findings reveal a cross-lagged association between spiritual/religious support and health and highlight the moderating role of regional Healthcare Access and Quality. Spiritual/religious support is associated with better health in contexts with limited healthcare, possibly functioning as a partial compensatory resource.