Identify the instrument or instruments used to quantify the data,  the level of measurement for each instrument, and the statistics used  to analyze the data.

Refer to the study that uses quantitative methods that you chose for discussion in Unit 1 to complete this discussion. Note:  If the article that you selected in Unit 1 will not allow you to  thoroughly address all of the points required for this discussion, you  will need to search for another study using quantitative methods.

Based on what you have learned from the readings assigned for this unit, address the following:

  • Identify the instrument or instruments used to quantify the data,  the level of measurement for each instrument, and the statistics used  to analyze the data.
  • Identify and describe the constructs, variables, and operational  definitions included in the research. Do not just list terms. Include a  description of how the researcher defined these.
  • Describe the cognitive tool used to interpret the data.  Possibilities include deductive logic, inductive reasoning, scientific  method, or critical thinking.
  • Discuss the usefulness of the operational definitions for the  constructs in this study. How could they have been defined differently?  Were the operational definitions sufficient to allow the researcher to  answer the research question? Make sure to justify your answer.
  • Explain the importance of operational definitions to scientific merit.
  • List the persistent link for the article. Use the Persistent  Links and DOIs library guide, linked in the Resources, to learn how to  locate this information in the library databases.
  • Cite all sources in APA style and provide an APA-formatted reference list at the end of your post.Persistent link

    https://search-proquest-com.library.capella.edu/docview/1985859541/fulltextPDF/F5256BEE3BF74331PQ/1?accountid=27965

    This is the reference for this article:

    Johnson, E. T., Kaseroff, A., Flowers, S., Sung, C., Iwanaga, K., Chan, F., . . . Catalano, D. (2017). Psychosocial mechanisms explaining the association between spirituality and happiness in individuals with spinal cord injuries. The Journal of Rehabilitation, 83(4), 34-42.

    Abstract

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    The main objective of this study was to examine health status, perceived stress, social support, self-esteem and psychological well-being as mediator variables for the relationship between spirituality and happiness. Quantitative descriptive research design using multiple regression and correlation techniques was used. Participants were 274 individuals with spinal cord injuries (SCI) recruited from the Alberta, Manitoba, Nova Scotia, Ontario, and Saskatchewan chapters of the Canadian Paraplegic Association. All of the five mediators were significantly associated with happiness. The five-mediator model accounted for 68% of the variance in happiness. The findings confirm spirituality is associated with happiness indirectly through its association with perceived stress, health status, social support, self-esteem, and psychological well-being, each of which is uniquely associated with happiness. Rehabilitation counselors should consider integrating spiritual interventions with health promotion interventions in vocational rehabilitation services for individuals with SCI to improve outcomes in life satisfaction.

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    Headnote

    The main objective of this study was to examine health status, perceived stress, social support, self-esteem and psychological well-being as mediator variables for the relationship between spirituality and happiness. Quantitative descriptive research design using multiple regression and correlation techniques was used. Participants were 274 individuals with spinal cord injuries (SCI) recruited from the Alberta, Manitoba, Nova Scotia, Ontario, and Saskatchewan chapters of the Canadian Paraplegic Association. All of the five mediators were significantly associated with happiness. The five-mediator model accounted for 68% of the variance in happiness. The findings confirm spirituality is associated with happiness indirectly through its association with perceived stress, health status, social support, self-esteem, and psychological well-being, each of which is uniquely associated with happiness. Rehabilitation counselors should consider integrating spiritual interventions with health promotion interventions in vocational rehabilitation services for individuals with SCI to improve outcomes in life satisfaction.

    At the onset of a traumatic disability, such as a spinal cord injury (SCI), a person’s spiritual beliefs may provide a mechanism for healing and coping with stress (Marini & Glover-Graf, 2011). The physical and psychological effects of sustaining a SCI may require individuals to reevaluate their worldview in order to successfully adjust to a newly acquired disability identity. A person’s worldview is molded by spiritual influences including his or her thoughts and beliefs concerning life, death, and suffering (Littooij et al., 2016). As such, spirituality impacts how a person adapts to an acquired disability.

    In the fields of health and rehabilitation, an extensive body of literature addresses the relationship between spirituality and health outcomes. However, the majority of research has focused on individuals with terminal health conditions (e.g., end stage cancer), who may use spiritual and religious coping as a way to make peace with their illness, resolve lingering issues, and prepare for death. As medical and technological advances extend longevity, improve health and function, and facilitate independent living, the influence of spirituality for a person living with a disability, such as SCI may be different. Spiritual and religious beliefs may facilitate positive adjustment by helping individuals with disabilities maintain health status, manage the daily stress of coping with a disability, find new meaning and purpose, and establish new life goals (Johnstone et al., 2007; Johnstone, Franklin, Yoon, Burris & Shigaki, 2008).

    Despite empirical evidence linking spirituality and health outcomes, the relationship between spirituality and positive psychosocial adjustment to disability has not been adequately investigated. A recent scoping review of 26 studies addressing spirituality and psychosocial adjustment for persons with SCI does provide some evidence that spirituality plays a contributing role in adjustment post-SCI (Jones, Simpson, Briggs, and Dorsett, 2016). However, the mechanisms via which spirituality influences psychosocial adjustment remains unclear, resulting in a gap in knowledge. Considering depression and rates of suicide for persons with SCI are higher than people without disabilities, (Marini & Glover-Graf, 2011), it is important to further investigate psychosocial mechanisms, such as spirituality, that may improve mental health and quality of life for persons with SCI to mitigate potential negative outcomes.

    Spirituality and Happiness

    Spirituality has long been associated with better health, a longer life span, and greater levels of happiness and life satisfaction (Udermann, 2000). Martinez and Scott (2014) identify spirituality as a strong psychosocial predictor of happiness implying spirituality influences engagement in meaningful daily activities which then influences happiness. For persons with disabilities, one study shows spirituality is a strong predictor for happiness, controlling for inflammation, pain and stiffness, physical functioning, age, and mood in those diagnosed with rheumatoid arthritis (Bartlett, Piedmont, Bilderback, Matsumoto, & Bathon, 2003). In another study, a spiritualty-based intervention led to increased hope, happiness, and life satisfaction in breast cancer survivors (Fallah, Golzari, Dastin, & Akbari, 2011). These studies elucidate the need to further investigate of the impact of spirituality and mental health outcomes including happiness and well-being.

    Psychosocial Mechanisms

    Due to an emerging conceptual framework highlighting spirituality as an important positive coping strategy for psychosocial adaptation to chronic illness and disability, the need for further research forms the basis for the current study. Specifically, we examine the underlying psychosocial mechanisms by which health status, perceived stress, social support, self-esteem, and psychological well-being influence the relationship between spirituality and happiness based on the following summative review of the literature.

    Health status. The relationship between spirituality and health status has been well-documented in the literature. Research indicates spirituality and regular engagement in spiritual practices, such as prayer and service attendance, are strong predictors of general health status independent of age, level of education, and socioeconomic status (Krause, Emmons, & Ironson, 2015; Ferraro & Albrecht-Johnson, 1991). Spirituality also plays a role in recovery and healing. For example, in a study of heart-transplant recipients, those persons who reported strong spiritual beliefs and regular spiritual service attendance adhered more closely to their rehabilitation plan, had higher physical functioning levels, and better indexes of emotional wellbeing (Harris et al., 1995). Hudson (1996) states the beneficial effects of spirituality are not just limited to individuals with strong spiritual beliefs prior to the onset of illness. In Hudson’s study, those who increased their level of spiritual commitment while in treatment reported their health as better than the health of those who did not. In Cheadle and Schnetter’s (2017) summative review of the spirituality and health status literature, they indicate four underlying mechanisms linking the two variables including (1) social mechanisms (e.g., social interactions and support), (2) behavioral mechanisms (e.g., religious/spiritual practices such as medication and prayer which may reduce anxiety), (3) psychological mechanisms (e.g., finding purpose and meaning in life) and (4) biological mechanisms (e.g., reduction in stress and inflammatory biomarkers). Based on these findings, the potential influence of spirituality on the health status of persons with SCI cannot be ignored.

    Perceived stress. People with chronic illness have to cope with high levels of stress that pose a barrier to their happiness and well-being, particularly those who have acquired a severe injury such as SCI (Livneh & Wilson, 2003). For instance, individuals with SCI have indicated bowel or bladder accidents, secondary injuries, and public embarrassment are disability-related sources of stress (DeGraff & Schaffer, 2008). Research indicates that a reduction of stress is associated with greater levels of life satisfaction in older adults (Lee, Besthom, Bolin, & Jun, 2012), individuals with psychiatric and physical disabilities (Livneh & Wilson, 2003), and individuals with SCI (DeGraff & Schaffer, 2008). Specifically, for persons with SCI, spiritually-based interventions did arise as a valuable coping resource for dealing with stress (DeGraff & Schaffer, 2008). The use of spirituality as a coping mechanism to reduce stress is clear, and suggests further exploration of stress as a mediator of the relationship between spirituality and happiness is necessary.

    Social support. Spirituality can positively affect subjective appraisal of social support by increasing (a) individuals’ perception of closeness and connection to others and (b) the frequency and quality of social contacts. McColl et al. (2000) explored changes in spiritual beliefs in eight people with either traumatic brain injury or SCI less than two years post-injury. Post-injury, McColl and colleagues found respondents expressed increased feelings of connection and greater closeness with others, the world, or God. Preliminarily, there is some evidence to indicate social support may be a mediator for spirituality and happiness. In an exploratory study examining the impact of spiritual and religious beliefs and practices on life satisfaction for people living with SCI, Marini and Glover-Graf (2011) found, while half of the study participants reported feeling closer to God, and nearly twothirds felt closer to others, 10% of respondents reported lasting anger at God. This same 10% indicated feeling abandoned and punished by God, and that the disability made them a worse person. These beliefs have important implications for rehabilitation professionals, as anger, hostility, resentment, and contempt for others may cause persons to alienate loved ones and withdraw from social interaction with others. This withdrawal and alienation can potentially damage main sources of social support, and negatively influence life satisfaction for persons with SCI. As such, further investigation of the mediating influence of social support on the relationship between spirituality and happiness is warranted.

    Self-esteem. In a narrative review of psychosocial concerns for persons with SCI, Post and van Leeuwen (2012) show hope, having a sense of purpose in life, and a sense selfworth and self-esteem, significantly affect subjective well-being post-SCI. Individuals with SCI indicated post- injury, they felt a great sense of purpose, or their purpose had become more urgent (McColl et al, 2000). Marini and Glover-Graf (2011) indicate faith and spirituality contribute to higher levels of physical and mental health well-being by increasing levels of hope and positive expectation for persons with SCI. Based on the emerging literature, investigating self-esteem as a mediating variable in the relationship between spirituality and happiness is conceptually and empirically sound.

    Psychological well-being. Spirituality has shown to have both mediating and moderating effects on aspects of psychological well-being. As a moderator, spirituality reduced the depressive effects of chronic illness on psychological well-being (Ballew, Hannum, Gaines, Marx, & Parrish, 2012). As a mediator, Meraviglia (2006) found the spirituality factor of “meaning in life,” in conjunction with physical functioning, explained 43% of the variance in the psychological well-being in a sample breast cancer survivors. The results of these studies clearly indicate a connection from spirituality to psychological well-being, suggesting positive well-being as a viable mediator between spirituality and happiness. This connection will be further explored in the current study.

    Purpose of the Study

    Clearly, there is strong support in the psychosocial literature for the mediating effects of the aforementioned variables, the purpose of this study is to evaluate the extent health status, perceived stress, social support, self-esteem, and psychological well-being serve as underlying psychosocial mechanisms to explain the association between spirituality and happiness.

    Research Hypothesis

    1. The relationship between spirituality and happiness is mediated by health status, perceived stress, social support, self-esteem, and psychological well-being.

    Methods

    Sample

    Two hundred and seventy-four individuals with SCI were recruited from the Alberta, Manitoba, Nova Scotia, Ontario, and Saskatchewan chapters of the Canadian Paraplegic Association (CPA). Research packets were mailed directly by these CPA chapters to members to ensure confidentiality and anonymity. The inclusion criteria for this study were as follows: (a) have an acquired SCI, (b) be at least 18 years of age, and (c) be able to read and understand English.

    Participants ranged in age from 18 to 82 years (M = 46.82, SD = 13.46). More than half of the participants were men (68%) and the majority described themselves as White (84%). Participants in this study were relatively well educated with 77% having some level of postsecondary education and training. More than half of the participants were married or in a significant long-term relationship (56%). With regard to employment, 45% worked either full-time or part-time, 46%% were retired or not seeking employment, 9% were seeking employment. The mean duration since injury onset was 17.33 years (SD = 11.94). The proportion of participants who reported having quadriplegia/tetraplegia was 44% (19% with a complete lesion, 25% with an incomplete lesion).

    Measures

    Participants completed seven empirically validated instruments with strong psychometric properties assessing the predictor and outcome variables described in the following sections.

    Spiritual Health Inventory (SHI). The SHI was developed by Veach and Chappel (1992) to assess perceptions of spirituality. It is composed of 18 items and three subscales: (a) Spiritual Experience, (b) Spiritual Locus of Control, and (c) Spiritual Well-Being. Only the 9-item Spiritual Well-Being subscale was used for the purpose of this study (e.g., “I have an internal experience of being accepted for who I am,” “Life has a purpose,” and “1 believe my life has meaning”). Each item is rated on a 5-point Likert-type rating scale ranging from 1 (strongly disagree) to 5 (strongly agree) with higher scores reflecting a greater perception of spiritual well-being. The internal consistency reliability estimates (Cronbach’s alpha) for the Spiritual Well-Being subscale was reported to be .72 (Veach & Chappel, 1992). Support for the validity of the SHI is based on positive correlations with measures of physical and psychological health (Veach & Chappel, 1992). Cronbach’s alpha coefficient for the Spiritual Well-Being subscale in the present study was computed to be .89.

    Rand Short-Form 36-General Health Scale. The SF36 is a generic health-related quality of life measure with 36 items and eight subscales: (a) Physical Function-10 items, (b) Role Limitations due to Physical Health-4 items, (c) Role Limitations due to Emotional Problems-3 items, (d) Energy/ Fatigue-4 items, (e) Emotional Well-being-5 items, (f) Social Functioning-2 items, (g) Pain-2 items, and (h) General Health-5 items. The two summary measures of the SF-36 are referred to as Physical Component Summary and Mental Component Summary. In this study, only the general health subscale comprised of five items was used to assess the general health status of the participants (i.e., “In general, would you say your health is…,” “I seem to get sick a little easier than other people,” “I am as healthy as anybody I know,” “I expect my health to get worse,” and “My health is excellent”). Each item is rated on a 5-point Likert-type scale and then rescaled to a 0-100 point scale with higher average score reflecting higher level of general health. The internal consistency reliability estimates (Cronbach’s alpha) was reported to be .78 (Ware & Sherbourne, 1992). Cronbach’s alpha coefficient in the present study was computed to be .81.

    Perceived Stress Questionnaire (PSQ). The PSQ was developed by Levenstein et al. (1993) to assess subjective experience of stressful situations in the last month and stress reactions on cognitive and emotional levels. It is composed of 30 items and seven subscales: (a) Harassment, with four items (e.g., “You are under pressure from other people”); (b) Overload, with four items (e.g., “You have too many things to do”); (c) Irritability, with two items (e.g., “You are irritable or grouchy”); (d) Lack of joy, with seven items (e.g., “You enjoy yourself’); (e) Fatigue, with four items (e.g., “You feel rested”); (f) Worries, with five items (e.g., “You are afraid for the future”); and (g) Tension, with four items (e.g., “You have trouble relaxing”). Each item is rated on 4-point Likert-type rating scale ranging from 1 (almost never) to 4 {usually). In this study, the total scale was used to assess stress levels of the participants, with higher scores reflecting greater perceived stress. The PSQ was validated among English-speaking and Italian-speaking samples including gastroenterological inpatients, outpatients, and hospital employees, and was found to have high internal consistency and test-retest reliability (Fliege et al., 2005; Kocalevent et al., 2007; Levenstein et al., 1993). Cronbach’s alpha for the PSQ in the current study was .93.

    Multidimensional Scale of Perceived Social Support (MSPSS). The MSPSS was developed by Zimet, Dahime, Zimet, and Farley (1988) to assess perceived social support from multiple sources. The instrument is composed of 12 items and three subscales: (a) Family, with four items (e.g., “I can talk about my problems with my family”), (b) Friends, with four items (e.g., “I can count on my friends when things go wrong”), and (c) Significant Others, with four items (e.g., “There is a special person who is around when I am in need”). Each item is rated on a 7-point Likert-type ranging scale ranging from 1 {very strongly disagree) to 7 {very strongly agree). Scores for each subscale are represented by the mean of the raw scores for items in the subscale and a total score is represented by the mean of the scores obtained on the three subscales. In this study, the total scale was used to assess social support level of the participants, with higher scores reflecting greater perceived social support. Reported evidence supporting the psychometric properties of the MSPSS include its inverse relationship to the depression and anxiety subscales of the Hopkins Symptom Checklist and reported high test-retest reliability coefficients of .85 for the total scale and .97, .85, and .91 for the Family, Friends, and Significant Others subscales, respectively (Zimet et al., 1988). Cronbach’s alpha coefficients for the Family, Friends, and Significant Others subscales and the total scale in the current study were computed to be .93, .93, 96, and .81 respectively.

    Rosenberg Self-Esteem Scale (RSES). The RSES was developed by Rosenberg (1965) to evaluate global self-worth by measuring both positive and negative feelings about the self. It is composed of five positively worded (e.g., “I feel that I have a number of good qualities”) and five negatively worded (e.g., “At times I think I am no good at all”) items. Each item is rated on a four-point Likert-type rating scale ranging from 1 {strongly disagree) to 4 {strongly agree), with higher scores indicate higher self-esteem. Studies using the RSES report test-retest reliabilities ranging from .72 to .90 (Robins, Heiden, & Trzesniewski, 2001) and Cronbach’s alpha between .77 and .88 (Blascovich & Tomaka, 1993). Cronbach’s alpha for the RSES in the current study was .88.

    Sense of Well-Being Inventory (SWBI). The SWBI was developed by Rubin, Chan, Bishop, and Miller (2003) to operationalize the construct of quality of life for vocational rehabilitation clients. The original SWBI has 36 items and five subscales. Recently, Catalano et al. (2010) has validated an abbreviated version of the SWBI. The abbreviated SWBI is composed of 20 items and four subscales: (a) Financial Well-being, with five items (e.g., “I feel good about my financial future”); (b) Family and Social Well-being, with five items (e.g., “I have friends who care about me” and “I receive emotional support from my family”); (c) Psychological Well-being with six items (e.g., “I frequently feel down,” “I frequently feel nervous,” and “I feel good about myself’); and (d) Physical Well-being with four items (“I feel good about my physical stamina and energy level”). Each item is rated on a four-point Likert-type rating scale ranging from 1 {strongly disagree) to 4 {strongly agree). Only the psychological well-being subscale was used for the purpose of this study. The reported internal consistency estimate for the instrument was found to range from.81 to .85, with the Cronbach’s alpha reported to be .82 for the Psychological Well-being subscale (Catalano et al., 2010). Cronbach’s alpha for the psychological well-being in the current study was .81.

    Subjective Happiness Scale (SHS). The SHS was developed by Lyubomirsky and Lepper (1999) as a global measure of subjective happiness. The instrument comprises only four items. An example of items included in this instrument is “Some people are generally very happy. They enjoy life regardless of what is going on, getting the most out of everything. To what extent does this characterization describe you?” Each item is rated on a 7-point Likert-type scale ranging from 1 (“not a very happy person “, or “not at all”) to 7 (“a very happy person “, or “a great deal”). A total score of happiness is obtained by computing the mean of the scores with higher means reflecting a higher level of happiness. The reported internal consistency estimate for the instrument was found to range from .79 to .94. Test-retest reliability coefficients were found to range from .55 to .90. Convergent validity was supported based on correlations with related constructs, such as self-esteem, optimism, positive emotionality and negative emotionality, extraversión and neuroticism, and dysphasia (Lyubomirsky & Lepper, 1999). Cronbach’s alpha for the SHS in the current study was .87.

    Data Analysis

    The primary analysis was conducted using multiple regression analysis to test the hypothesis that the association between spirituality and happiness is mediated by reduction in stress level, improved health status, stronger social support, improved self-esteem, and better psychological well-being. In addition, the bootstrap test for multiple mediators developed by Preacher and Hayes (2008) was used to test the significance of the indirect effects of the independent variable (IV; spirituality) on the dependent variable (DV; happiness) through the mediators (perceived stress, general health status, social support, self-esteem, and psychological well-being).

    Results

    Prior to analysis, perceived stress, general health status, social support, self-esteem, psychological well-being, and happiness were examined for accuracy of data entry, missing values, and fit between distribution of variables and the assumption of multiple regression analysis. All measures in this study have less than 5% missing values. A simple imputation method available in SPSS using regression analysis was used to compute missing value estimates. This method is preferred over case deletion since it will not decrease the sample size (i.e., statistical power loss) or affect the sample representativeness. Using Mahalanobis distance with p < .01, six cases (2%) were identified as multivariate outliers and eliminated from the study.

    Descriptive Statistics

    Means, standard deviations, and the correlation matrix for variables in the hypothesized mediational model are shown in Table 1.

    The average spirituality rating of 3.65 (SD = 0.81; range 1 to 5) indicated relatively high spirituality scores for participants in this study. The mean perceived stress score was 2.04 (SD = 0.50; range 1 to 4). The general health scale had a range of 0 to 100 and the average score for this sample was 56.58 (SD = 21.40), indicating participants rated their health status as “fair” or average. The average rating for social support was 5.38 (SD = 1.33; range 1 to 7). The mean score for self-esteem was 3.13 (SD = 0.55; range 2 to 4). The psychological well-being scale had a mean of 2.87 (SD = 0.57; range 1 to 4). The mean happiness score was 5.08 (SD = 1.31; rangel to 7).

    As presented in Table 1, Pearson product-moment correlation coefficients generally ranged from medium to large among the dependent variable and the predictor variables in the correlational matrix, with all correlations significant at p < .001. Perceived stress was inversely related to spirituality (r = -.35), happiness (r = -.65), health status (r = -.43), social support (r = -.38), self-esteem (r = -.62), psychological well-being (r = -.67).

    Testing the Mediational Hypothesis

    The Baron and Kenny (1986) procedure was used to test the mediational hypothesis of the relation between spirituality and happiness. This procedure involves three steps:

    1. Regress the mediator (M) onto the independent variable (X) to show the two variables are causally linked.

    2. Regress the dependent variable (Y) onto the X to show a causal relation between the variables are plausible.

    3. Regress the dependent variable (Y) simultaneously onto the IV and the mediator to show the mediator is significantly related to the DV, even when the IVs is statistically controlled.

    If the regression coefficients for steps 1 and 2 are significant, and the partial regression coefficient for predicting the DV from the mediator is significant in step 3, a mediator hypothesis is supported (Baron & Kenny, 1986). In this study, it was hypothesized that the association between spirituality and happiness is mediated by perceived stress, health status, social support, self-esteem, and psychological well-being. This model is graphically depicted in Figure 1 and was tested using seven separate regression equations.

    As expected, the association between spirituality (IV) and happiness (DV) (step 2) was significant: ß (95% confidence interval [Cl]) = .58 (.48, .68). (Note: When the 95% Cl excludes 0, the effect size differs significantly from zero, p < .001.) Next, the association between the IV (spirituality) and each of the mediators (step 1) was assessed. Spirituality was significantly related to perceived stress, health status, social support, self-esteem, and psychological well-being: ßs (95% Cis) = -.35 (-.46, -.24), .28 (.17, .40), .49 (.39, .60), .52 (.42, .63), and .55 (.44, .65) respectively. Finally, each of the presumed mediators was significantly related to the DV (hap- piness), while statistically controlling for the IV (step 3). The relevant analysis was a simultaneous regression of happiness (DV) onto spirituality (IV), perceived stress, health status, social support, self-esteem, and psychological well-being. The reason for including all five mediators and the IV in the regression equation is related to the path model in Figure 1, which implies that each mediator is uniquely related to happiness (DV), controlling for the other mediators and spirituality (IV). The model accounted for 68% of the variance in happiness, R = .83, R^sup 2^ = .68, F{6, 261) = 93.89, p < .001, and is considered a large effect size (Cohen, 1988). All of the five mediators were significantly associated with happiness, ßs (95% Cis) = -.18 (-.28, -.08), .14 (.06, .22), .10 (.02, .18), .18 (.07, .30), .30 (.17, .42) for perceived stress, health status, social support, self-esteem and psychological well-being, respectively. In summary, all three steps were significant as predicted, yielding support for the proposed mediation model. The findings conform to the predictions of a model in which spirituality is associated with happiness indirectly through its association with perceived stress, health status, social support, self-esteem, and psychological well-being each of which is uniquely associated with happiness.

    In addition, the association between spirituality and happiness in the final (six-predictor) regression equation was examined. This was also statistically significant, ß (95% Cl) = .17 (.08, .26). The ß for spirituality was reduced from .58 to .17, after controlling for the effect of the mediators. Thus, while the intervening variables (perceived stress, health status, social support, self-esteem, and psychological well-being) help to explain the link between spirituality and happiness, they do not completely explain the relationship. The finding of significant indirect effects through one or more mediators accompanied by significant direct effects, is common and was characterized by Baron and Kenny (1986) as a case of partial mediation.

    Finally, we conducted a bootstrap test to determine the significance of the indirect effect of the IV on the DV through the mediators. The indirect effect for the mediation model was tested using a SPSS macro for conducting bootstrap tests of multiple-mediator models downloaded from Kristopher Preacher’s website (www.people.ku.edu/preacher/). For the mediation model, the unstandardized indirect effects (with 95% CIs derived from bias-corrected and accelerated bootstrap procedures) were products (ab) = .06 (.03, .11) for the indirect path through perceived stress and happiness; .04 (.02, .07) for the indirect path through health status and happiness; .05 (.01, . 10) for the indirect path through social support and happiness; .09 (.03, .16) for the indirect path through self-esteem and happiness; and .16 (.09, .25) for the indirect path through psychological well-being and happiness. Given that the individual paths a and b were significant for each mediator, the 95% CIs do not include zero indicating that the indirect effect is significant (p < .05) in each case.

    Discussion

    The researchers in this study recruited 274 individuals with SCI from five chapters of the Canadian Paraplegic Association and administered seven measurement instruments addressing health, spirituality, social support, self-esteem, stress, well-being and happiness through multiple regression and a bootstrap test for multiple mediators to show the relationship between happiness and spirituality is mediated by the above seven factors. Findings confirmed the link between happiness and spirituality, as well as the mediating effect of the other factors.

    Seligman’s (2008) positive psychological movement, with its focus on strengths and virtues, has permeated the field of health and rehabilitation research and practice, a movement he entitles “positive health” (p.3). This strengths-based framework highlights the hallmark of the fields of rehabilitation counseling and psychology-enhancing the quality of life of persons with chronic illness and disability as elucidated in the early seminal writings of Beatrice Wright (1983). This study examined positive psychological constructs in a population of persons with SCI. The purpose of this study was to explore how health status, perceived stress, social support, self-esteem, and psychological well-being mediate the relationship between spirituality and happiness. First, the relationship between spirituality and happiness was examined and this relationship was found to be significant. This finding adds additional support to recent findings by Martinez and Scott (2014) indicating spirituality is an important contributing factor to happiness, specifically engaging in meaningful activities enables a person to feel connected to something outside of himself, searching for significance in life, and positively adapting to events that challenge a person’s sense of meaning (e.g., onset of a traumatic disability such as SCI).

    Next, we tested a mediational model to determine the extent to which health status, perceived stress, social support, self-esteem, and psychological well-being explained the relationship between spirituality and happiness. This hypothesized mediational model explained 68% of the variance in happiness, a large effect size. Thus, these five variables ex- plain the mechanism through which spirituality influences happiness.

    Results of this study have important clinical rehabilitation counseling implications. Rehabilitation counselors and psychologists working with persons with SCI can adapt spiritual interventions that focus on health promotion, stress reduction, increasing social support networks, building the person’s self-esteem and psychological well-being. Using a spiritual framework as a basis for intervention, would have a positive effect on the psychological well-being and happiness of persons with SCI. For example, Honarparvaran, Ghaderi, Bayat, and Cheraghi (2014) show group counseling with an existential framework focusing on self-determination, values, choice, and meaning can facilitate spiritual growth in persons with SCI. This spiritual growth may lead to a greater sense of self, inner peace, acceptance, and happiness because “positive values, attitudes, beliefs and strength that one acquires through spiritual practices contribute to health and happiness” (Sinha, 2014, p. 396).

    Individually, each predictor variable significantly influenced happiness, thereby adding to the body of literature in this area. As in this study, Graham (2008) found self-reported health status was a strong predictor of happiness worldwide. For persons with chronic illness and disability, Graham states initially the illness or disability may have a negative impact on happiness. Over time, persons with chronic illness and disability return to their initial level of happiness once expectations for health status shift in relation to their condition. This shift portrays how the locus of evaluation for health status shifts from the general population to those persons with similar conditions. In alignment with the findings this study, Schiffrin and Nelson (2010) found support for the intuitive inverse relation between perceived stress and happiness. Siedlecki, Salthouse, Oishi, and Jeswani (2014) found family embeddedness (i.e., frequency of contact) and provided support (i.e., emotional, tangible, or informational help) predicted positive affect, a proxy for happiness in their study. This study provides additional supporting evidence for the relationship between those two variables. In spiritually focused interventions aimed at increasing happiness for persons with SCI, self-esteem should be addressed. As Nosek, Hughes, Swedlund, Taylor, and Swank (2003) report, for women with disabilities, self-esteem is significantly associated with engaging in health promoting behaviors and employment, key factors influencing overall quality of life for this population. Addressing psychological well-being for persons with SCI is essential as previous literature suggests. Perceived loss of physical functioning is associated with psychological well-being; however, global meaning making mediates the relationship between perceived loss of physical functioning and psychological well-being (deRoon-Cassini, de St. Aubin, Valvano, Hastings, & Horn, 2009).

    Thus, psychological interventions are indeed necessary to improve the quality of life of persons with SCI. The prevalence of depression, anxiety, and post-traumatic stress disorders is higher for persons with SCI compared to the general population (Post & van Leeuwen, 2012). In a review the literature, Post and van Leeuwen show life satisfaction, a proxy for happiness, is lower initially following SCI and life satisfaction improves over time. This trend is important as interventions aimed at increasing self-esteem, finding ways to cope with newfound stressors, and finding a strong support network as early as possible after medical rehabilitation may help to improve psychosocial outcomes for persons with SCI. This potential for effective intervention is supported by previous research showing positive psychological constructs greatly influence subjective well-being in persons with SCI post- acute rehabilitation (Kortee, Gilbbert, Gorman, & Wegener, 2010).

    Although the results of this study provide support for the mediational model, the five predictor variables did not completely explain the mechanism by which spirituality influences happiness in persons with SCI. Future studies should examine other potential positive psychological constructs as predictors such as optimism, hope, and resiliency to determine if the addition of variables such as those completely explain the link between spirituality and happiness.

    Concluding Statements

    In this article, we explored the relationship of spirituality and happiness, specifically spirituality and happiness for individuals with SCI and the mediating factors of health status, perceived stress, social support, self-esteem and psychological well-being. Each of these variables taken alone have an individual effect on happiness and spirituality both. This study found a significant association between spirituality and happiness for people with SCI; while each of the variables could explain this association, the explanation was not complete. Future studies would do well to continue research to find a more complete link between spirituality and happiness. An individual’s spirituality brings with it several positive effects on life happiness; a person with a SCI can likewise benefit from these positive effects. We know individuals with SCI experience many encroachments to life satisfaction, but happiness and life satisfaction can fundamentally return. Rehabilitation counselors and psychologists can facilitate quality of life improvements for people with SCI through interventions that include the individual’s spirituality and all correlating factors therein. As spirituality is linked to better health and life satisfaction, and is seen as a positive coping strategy, further investigations will only further aid people with SCI in healing, coping and positive psychosocial adaptation.

    Sidebar

    Ebonee Traneice Johnson, Ph.D., CRC, Assistant Professor, The University of Iowa College of Education-Rehabilitation and Counselor Education, N364 North Lindquist Center, Iowa City, IA 52242

    Email: ebonee-johnson@uiowa.edu

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