**5.5 SWB and social environment**

Among a sample of low-income African American mothers, Lamis et al. [44] explored whether EWB and RWB were moderators for neighborhood disorder and parenting stress. EWB predicted greater income, being employed, having a home, and lower probability of receiving treatment for psychiatric conditions. Higher levels of EWB and RWB were also related to fewer reports of experiencing recent

interpersonal violence. Neighborhood disorder was positively related to parenting distress, but those with higher scores on EWB and RWB reported less parenting distress. There was also a significant interaction between EWB and neighborhood disorder. Mothers who reported low levels of EWB reported greater levels of parenting stress regardless of neighborhood disorder, while those who reported high levels of neighborhood disorder also reported high levels of parenting distress despite reporting medium or high levels of EWB. High EWB may be an important protective factor against parenting distress in the presence of social disorder, but does not preclude distress in the face of more serious neighborhood disorder.

## **6. Religious/spiritual well-being**

Paloutzian et al. [10] argued that the inclusion of patient's spiritual well-being (SWB) in healthcare policy is an essential component to a comprehensive program of patient care. Since then, the body of research interested in examining a modern holistic view of the human being has grown to further embrace a spiritual dimension. Of particular interest to the current work, in the last decade researchers have emphasized exploration of the spiritual dimensions of health and its meanings and propose that inclusion of the biopsychosocial-spiritual model in medical practice may have profound effects on patient health, disease, treatments, and cure [45]. As the modern humanistic view of health gains momentum in healthcare, the interest gives way to development of ancillary analyses of patient care experiences including patientprovider relationships, patient subjective experience, and patient decision-making [44]. In this section, we assess the latest movement of the empowerment of patients through inclusion of patient SWB in a variety of healthcare settings. Additionally, we examine whether clinicians' perception of transcendence, or their level of SWB, will enable them to better impact and understand their clients.

As research around spirituality and its influence on overall health expands, it is salient to examine the willingness or resistance of clinicians and patients to incorporate this dimension into their practice. In one experiment, Saad et al. [45] posed the challenge of translating all phrases from the Physician's Pledge on the Declaration of Geneva to a spiritual dimension; following a full translation, researchers found spirituality as a dominant aspect of high standard medical training and clinical practice. As noted by the World Psychiatric Association [46], high-quality physician care is significantly associated to better mental health. This continuum of patient care can be perceived as a transformation of modern medicine due to understanding and inclusion of the human spiritual dimension. Oxhandler and Parrish [47] compared five helping professions' (3500 licensed clinicians) views and behaviors regarding integration of clients' religion and spirituality (R/S) in clinical practice. They found positive attitudes and no variability across professions, indicating helping professionals' openness to spiritual integration in clinical settings.

In another study, researchers examined whether patients wanted their doctors to talk about spirituality. Data from a systemic search in 10 databases including 54 studies and 12,327 patients were used. From their results, Best and Olver [48] concluded that over half the sample thought it was appropriate for the doctor to inquire about spiritual needs, and a majority of the sample expressed interest in discussion of R/S in medical consultations. Salient to note, interest increased with education, personal religiosity, private insurance, less intensity of spiritual interaction, and increased severity of patient illness. These findings suggested that while patients may

### *The Spiritual Well-Being Scale (SWBS) as an Indicator of General Well-Being DOI: http://dx.doi.org/10.5772/intechopen.106776*

be initially resistant to inclusion of spirituality in treatment, they are curious about its effects and may be more willing to engage in a casual inquiry regarding R/S.

While it is apparent that modern healthcare has adopted a shift to emphasize spirituality in treatment, we are curious about the personality traits of individuals who incorporate R/S into their lives, and how this may be applied to overall health and happiness. Particularly, we question whether the character of a clinician can affect the outcome of a patient, and how a clinician's character is influenced by SWB. Beauvais et al. [49] examined the relationship between emotional intelligence (EI) and SWB in nursing students using the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT) and the Spiritual Well-Being Scale (SWBS). Results indicated relationships between managing emotion and spiritual and existential well-being. As the definition of EI has been broadened to identifying the feelings of self and others, findings suggest that higher scores on the SWBS indicated higher EI, or what some might call *empathy* [49].

Research by Hosseini et al. [50] incorporated the SWBS to address relationships between psychological hardiness and general/spiritual health and burnout among 312 medical science staff participants. Findings demonstrated that the hardiness variable had a highly significant relationship with spiritual health, meaning that increases in one were associated with increases in the other. These data can be extrapolated from the original idea behind SWB as a need for transcendence; people connected to their spirituality can engage in meaning-making of their experiences, which can provide beneficial effects on coping with difficult events and therefore, increased psychological hardiness. Also notable in this study was the burnout decrease/hardiness increase correlation. If clinicians can avoid burnout, their patients will surely benefit from longevity of treatment and clinician genuineness and competence.

In a recent survey, Levin [51] collected data from the 2010 Baylor Religion Survey from 1714 participants to investigate the prevalence and religious predictors of healing prayer use among US adults. Interestingly, results show that over 75% of adult Americans have prayed for the healing of others and over half have participated in prayer groups [50]. In support of these findings, Pew Research Center [52] gathered data that suggested over 90% of Americans believe in a Higher Power, and over half pray daily, many times for their own and others' healing. Integration of analyses from statistics such as these and various research suggests that humans crave, or are at least curious about spirituality and transcendence, and perceive beneficial effects from some level of SWB. With each adverse circumstance we experience, verifiable mechanisms of change can only encourage healing to a certain extent. Recent research provides promising evidence that clinicians and patients alike identify R/S as a significant factor beyond tangible measures of health that contribute to overall well-being.

Engel [53] showed that differentiation-of-self mediated the relationship between spiritual dwelling and RWB for negative affect but not for positive affect. They concluded that spiritual dwelling fosters well-being through regulation of negative affect.

### **7. Conclusion**

Shalom is found in the biblical texts of Exodus 21–22. In Israel today, when you greet someone or say goodbye, you say, Shalom. You are literally saying, "may you be full of well-being" or, "may health and prosperity be upon you." This brief review of the SWBS as a measure of the underlying concept of spiritual well-being provides

general support for the thesis that R/S well-being in many ways is consistent with the wishes and blessing associated with shalom. Supporting Engel and Sulmasy [53, 54], persons who score higher on the SWBS tend to cope better with medical adversity such as terminal cancer, experience better psychological health and are less likely to experience mental distress, have better social connections and less social strain, and function in ways that empower them to be a support and resource for those who suffer in these ways. While limited data bears on the direction of causality, there is some indication that spiritual well-being tends to play a causal role in these relationships.

Does spiritual well-being lead to happiness? Not necessarily. First, many of these findings lack the safeguards to ensure causal relationships, though a few findings meet that standard e.g. [18, 19, 55]. Second, spiritual well-being is a broader more experiential and existential quality rather than "the relative presence of positive affect, absence of negative affect, and satisfaction with life" used to define happiness. But the experience of holistic biopsychosocial and spiritual well-being [53, 54] is likely to be associated with a sense of calm, peace, satisfaction, contentment and abundance. At times these are likely to also be accompanied with happiness as well. And R/S engagement is generally associated with these experiences.
