INTRODUCTION:

Mood disorders are common in psychiatry and their characteristic is disturbance in regulating emotions. People affected with mood disorders, experience different emotions ranging from irritability to chronic depression. Mood disorders are better detected and understood due to their periodic and recurrent nature and disabling consequences related to recurrent periods. At the moment, these disorders are considered as one of common problems in health care due to economic costs and personal sufferings.¹ Mood disorders such as depression are the most common in psychiatry and they accompany with signs of reduction of energy and interest, feeling guilty, disturbance in concentration, anorexia, thinking about death and suicide.² Also, depression interferes with occupational performance, social relations, and interpersonal associations.³ Some researches show that functional, socio-physical disorders are higher in depressed patients than in non-depressed people.⁴ Some psychologists believe that depression brings about different states such as psychosomatic, obsessive-compulsive disorders and even psychosis.⁵ Among psychiatric disorders, depression (58%) is considered as the most important cause of committing suicide.⁶ Depression is accounted as the most common psychological disease during the century such that it is so-called “psychic cold”.⁷ According to statistics offered by Iran ministry of Health, prevalence of depression in society can be one of determinant factors of health index in the Iran society.⁸ Although this issue is very important and its high prevalence, recurrence, and chronic consequences require more attention, it is very important to be studied on youths. Prevalence of depression in university students is higher than others and about 54% of students suffer from depression. Factors such as unfamiliarity with environment of university or cultures (specially non-native students), being separated from the family, not being interested in academic field of study, mal-adaptation with other people in life and lack of economic-welfare facilities can bring about psychological problems including mood disorders (depression) and reduce performance of students.⁹

Prevalence of depression has been reported differently in Iranian students. Partovinejad reviewed studies on measuring prevalence of depression in several universities such as Qom, Mashahd, Kermanshah, and Birjand and reported depression prevalence between 1.2-5.3%.¹⁰ It is noteworthy that studies indicate that amount of prevalence of psychic disorders and diseases is increasing among students and they experience more depression and frustration compared to 30 years ago.¹¹ A study showed that disorders of mental health are higher in medical students than the society.¹² Rezaei findings suggested that 78% of medical students suffer from some signs of depression.¹³ In fact, medical students place in a special situation, in one hand they encounter with daily life stresses and on the other hand they face with one of the most stressful working places namely hospital, resulting in academic failure, functional disorder and other psychological disorders such as depression.¹⁴

Nowadays, most of experts believe that religion and religious acts might have positive effect on physical health and other dimensions of human being. Religious psychologists believe that psychological discomforts and life problems are seen in non-religious people more than others. In many literatures, it is indicated that religious affairs have a special place in promotion of mental health of people.¹⁴ One of religious affairs in Islam is Namaz that includes commands and orders about mental and physical health. Namaz role in coping with problems and crises made it as a popular activity in lives of many Muslim people.¹⁵ A study indicated that there is a significant correlation between depression and commitment to Namaz. The higher the commitment to praying Namaz, the depression was lower.¹⁶ Also, Moghrrab quoting from Bahreinina stated that committing suicide and depression are higher among people who have low commitment to praying Namaz.¹⁷ Another study showed that one, who committed suicide, had weaker religious attitude.¹⁸

Several studies have been conducted to assess the relation between religious commitment and tendency and mental health throughout the world and they had controversial results.^{19, 20} The study done by Hill et al. showed that there is a significantly positive relation between piety and different health dimensions.²¹ Another study indicated that people who are more religious, they are more satisfied with their lives and have lower depression.^22-26 Also Mogharabt quoting from Vahabzadeh stated that there is an inverse relation between religious beliefs and level of anxiety. Still another study showed that committing suicide has been significantly reduced in months of Muharram, Safar, and Ramadan.¹⁷ Bayani quoting from Ellis stated that piety is accompanied with unreasonable thinking and emotional disorders while Bayani quoting from Bergin rejected the relation between religion and psychopathology.²⁷ Mousa Rezaie quoting from Pargament has named 11 religious methods which caused and exacerbated psychological problems.²⁸ Therefore, the controversial results of previous studies in regard to this issue perused us to conduct the present study to determine the relationship between religious beliefs, commitment to ethical standards and Islamic rules in students of medical science university of Arak.

MATERIALS AND METHODS:

Study Design and Setting

This was a cross-sectional study. The population was all male and female students in fields of nursing & midwifery, dentistry, medicine, health, operation room, medical emergencies of Arak university of Medical Science.

Sampling and Sample Size

The stratified multistage random sampling was used to collect the data. Each faculty was considered as a stratum and classification was done according to number and gender of students. In present study, sample size was calculated 120 persons by using following formula:

Where Z₁ is confidence coefficient of 95% meaning 1.96, Z₂ is the test power coefficient of 80% meaning 0.84, r is estimation of correlation coefficient between score of religious beliefs and depression score that is at least 0.25

Instrument

Data were gathered by using Zung’s self-reported depression scale and researcher-made questionnaire of commitment to rules, beliefs, and ethical standards. Zung’s standard self reported depression scale includes 20 items and it was completed by subjects based on following Likert scale: always (4 points), often (3 points), sometimes (2 points), rarely (one point). Scoring the mood status is as follow: the point lower than 50 is a normal mood without psychopathology, 50-59 is mild to moderate depression, 60-69 is moderate to apparent depression and higher than 70 is chronic depression.²⁹ The second questionnaire includes two sections: the first section is about socio-demographic data and the second section is the questionnaire of studying commitment to Islamic rules, beliefs, and ethical standards. The dimension of commitment to Islamic rules includes 24 items, beliefs includes 25 items and ethical standards include 35 items and they were scored based on Likert scale as completely agree (4 points), to some extent agree (3 points), to some extent disagree (2 points) and completely disagree (one point). Concerning their negative scores, Items of 7 and 14-24 in Islamic rules dimension, items of 2, 6, 10, 16, 19 and 24 in beliefs dimension and items of 2, 4, 11 and 13 in ethical standards dimension were inversely scored. Concerning items’ scoring, the score range for religious commitment in different aspects of Islamic rules, beliefs, and ethical standards were 24-96, 25-100, and 35-140 respectively. In order to obtain face and content validity of the questionnaires, text books, literature and opinions of some professors of medical science university of Arak and Qom were used. Also a pilot study was done on 50 samples and the questionnaires were investigated regarding content and language clarity, easy application and the time required for their completion. The validity was confirmed accordingly. The value of Cronbach’s alpha was 0.76 that confirmed the questionnaire reliability.

Data Collection and Analysis

To collect the data four classes were chosen from each faculty randomly and a list of students from selected classes was prepared. Then based on number of students in each faculty, some of them were chosen by random numbers (proportional to amount of sample). Then one of the researchers who was aware of research goals and completion of the questionnaires referred to each student based on their student number and completed the questionnaire after introducing herself, explaining goals of research and taking consent. We use mean, standard deviation, frequency to describe the sample characteristics. Normality of the data distribution was confirmed by Kolmogorov-Smirnov Test. The relation between the depression score and commitment to Islamic rules, beliefs, and ethical standards scores were calculated by using Pearson correlation coefficient. SPSS version 18 was used to analyze the data.

Ethical Consideration

Arak University of Medical Science approved this project. After approval and getting permission, the researchers offered some oral information to the participants including the goals and objectives of the study, the confidentiality and anonymity of the data, and that they were free to withdraw from the study at any time. Verbal consent was given individually.

RESULTS:

In total 120 students participated in the study. 49% of the participants were females and 50.3% were males. 33.1% of the participants were from Nursing college, 7.6% from Medical college, 6.4% from Dental college, 4.5% from Midwifery College, 10.8% from Health College, 37.6% from Paramedical college. Mean age of samples was 21.32 ± 2.48 year. 87% of the participants were single, and 13% were married. Concerning academic degree, 14% had PhD, 5.1% had M.S degree, and 79% had B.S, and 1.9 % had associate degree. Most of students were studying in the third semester (24.8%). The mean of Grade Point Average of students was 16.19 ± 1.31. Based on results obtained from independent T test, no significant difference was seen between male and female students regarding depression and commitment to Islamic rules, beliefs, and ethical standards.

The mean score of depression was 43.1 ± 10.71. The mean scores of commitment to rules, beliefs, and ethical standards were 50.57 ± 8.36, 73.85 ± 17.96, and 57.66 ± 12.73 respectively. According to results of Pearson test, there was a significant negative relationship between commitment to Islamic rules and depression of students (r = -0.69, p= 0.000). Also there was a significant negative relationship between commitment to belief and depression (r= -0.49, p = 0.000) and between commitment to Islamic ethical standards and depression (r = -0.67, p = 0.000).

DISCUSSION:

According to the findings, there was a significant negative relationship between depression and commitment to Islamic rules, beliefs, and ethical standards. It means that the higher practical commitment to religion in students, they experience lower depression. These findings were significant and cannot be ignored. Believing in God as the source of hope and power, can be the main reason of such finding. Religion and praying are natural requirements of human being to a transcendent source and his worship and they are ancient forms of human life. Remembrance of God, thinking about his greatness, and philosophy of creation lead to relaxation in life. Having religious beliefs and behaviors such as trust in God, praying, commitment to rules and religious ethics result in internal tranquility via hope and persuasion to positive attitudes and promotion of mood status and prevention from depression.²⁶ To confirm this finding, Mousa Rezaei et al. reported that there is an inversely significant relationship between depression and religious orientation of students. It means that increase of religious orientation decreases depression in students.¹⁴ Also, this finding is in agreement with results obtained by Hill and Paragament²¹, Yi and Bjorck²², Shoakazemi²³, Amrai et al.²⁴, Tahmasbipour and Taheri²⁵, Marashian and Esmaili²⁶, and Braam et al.³⁰. Hill and Paragament reported that there was a significant relationship between religion, spirituality, and health in different dimensions including mental health.²¹ Also, the study done by Braam et al. showed that participation in religious activities reduces depression at the end of life. It also showed that lack of good feeling to God causes inappropriate adaptation styles in all ages resulting in manifestation of more signs of depression.³⁰ Concerning findings of Yi and Bjorck it was found that more religious people were more satisfied with their lives and had lower depression.²² Studies done by Shoakazemi suggest the positive and significant effect of strategies of religious adaptation on mental health patients with multiple sclerosis.²³ The study conducted by Amrai indicated that there was a negative association between religious awareness, anxiety, and depression of students.²⁴ Also, Tahmasbipour and Taheri reported that there was a significant relationship between religious attitude and depression.²⁵ The study conducted by Marashian and Esmaili suggested that there was a significant association between religious beliefs and psychological disorders.²⁶ A few studies reported that religion can be a ground for psychological disorders due to unreasonable thoughts^{27, 28} and rejected the relation between religion and psychopathology.²⁷

One of limitations of this study was its ethical and value aspects that possibly affected the findings. Another limitation was that this study was conducted on medical students so to confirm the findings; it is suggested to conduct the same study among different students. In addition, it is necessary to conduct longitudinal studies to explain effect of effective factors over the time.

In conclusion, it seems that practical commitment to religion can play a preventive role on depression and since depression is one of the most important psychological disorders among students throughout the world, it is recommended that more religious instructions are included in curricula of students in a proper form by qualified and specialized persons in field of religion and religious beliefs. In addition, cultural and religious centers could help students strengthen their religious beliefs by holding scientific workshops and sessions and explain coping strategies with depression via religion.

ACKNOWLEDGEMENT:

The researchers appreciate all students and professors who helped them in different stages of the study.

REFERENCES:

1- Seifsafari S, Firoozabadi A, Ghanizadeh A, Salehi A. A symptom profile analysis of depression in a sample of Iranian patients. Iran J Med Sci. 2013; 38:22-29.

2- Jamshidi N, Abbaszadeh A, Kalyani MN. Effects of video information on anxiety, stress and depression of patients undergoing coronary angiography. Pakistan Journal of Medical Sciences. 2009; 25(6): 901-905.

3- kaplan HL, sadock BJ. comprehensive texnbook of psychiatry. Vo12, Baltimore:wilims 2009.

4- Altin M, Terzi S. How does attachment styles relate to intimate relationship to aggravate the depressive symptoms. Procedia Soc Behav Sci, 2010; 2: 1008- 1015.

1. 5-Shamloo S. Mental Health. Tehran, Iran: Roshd Publication; 2012. [Persian]

5- Jahangiri K, Barkhordar N. The incidence of suicide and its related factors in the rural city of Kermanshah. J Med Coun Islamic Repub Iran. 2008; 2: 219-25. [Persian].

6- Sadeghi KH, Ahmadi SM, Rezaei M, Salehi M. The effect of eight weeks of aerobic exercises on depression and its cognitive components. JKUMS. 2013; 17(6): 343-350.

7- Vafaei M, Safavi M, salehi SH. Levels of anxiety, stress and depression and its relationship with BMI in nursing students. Journal of Medical Science Islamic Azad University. 2013; 23(2): 154-159.

8- Najafi Koliaei M, Pourjam E, Jamshidi N, Karimi S, Najafi Kalyani V. Survey stress, anxiety, depression and self- concept in students of Fasa University of Medical Sciences. JFUMS. 2013; 3(3): 235-239.[Persian].

9- Partovi Nejad A, et al. Comparison of depression in religious scholars & students of Qom University of Medical Sciences 2008. Journal of Qom University of Medical Sciences. 2010; 5(3): 49-52. [Persian].

10- Foroutani M. Depression in some college students. Iran J Nurs. 2005; 18(41): 123-30.

11- Asadi MH, Barati SF, Bahmani B, Sayah M. A study on general health and self-esteem of sportman medical University in 2nd sports olympiad. Teb va Tazkiyeh, 2002; 11(1): 43-9.

12- Rezie Adriani M, Azadi A, Ahmadi F, Vahedian Azmi A. Comparison of depression, anxiety, stress and quality of life in dormitories students of Tarbiat Modares University. Iran J Nurs Res. 2007; 2(4-5): 31-8.

13- MousaRezaie A, NajiEsfehani H, Khosravi N, Momeni-Ghaleghasemi T, Masaeli N. Relationship between commitment and priority to prayer with depression and some demographic parameters. Journal of Research in Behavioural Sciences. 2010; 10(6): 441-452. [Persian].

14- Aghapour I, Mesri M. Relationship between religious orientation and mental health family. Quran & Medicine 2011; 1(1): 39-45. http://quranmed.com/?page=article&article_id=4349

15- Musarezaie A, Naji-Esfahani H, Khosravi N, Momeni-Ghaleghasemi T, Masaeli N. Relationship between commitment and priority to prayer with depression and some demographic parameters. Journal of Research in Behavioral Sciences. 2013; 10(6): 441-452. http://www.sid.ir/fa/VEWSSID/J_pdf/4761391v0606.pdf

2. Ranaie F, Ardalan F, & zaheri F. Survey of relationship between attitude and practice toward prayer and depression in students of Kurdistan University of Medical Sciences. Teb Va Tazkieh, 2010; 19 (3): 75-83. http://www.sid.ir/fa/VEWSSID/J_pdf/55613897906.pdf

16- Mogharab M, Ghanad-e-Kafee M, Rezaee N. Relationship of depression and praying in Birjand University of Medical Sciences. Mod Care J, 2009; 6(1-4): 54-59.

17- Kikhavani S, Chatripor F, Seidkhaninahal A. Comparison Between Suicidal Thoughts and Depression Among the Suicide Committed and Healthy Individuals Among Ilam Province People Between 2011 and 2012. Scientific Journal of Ilam University of Medical Sciences. 2013; 21 (1): 47-53.

18- Galledar N. The effects of Quran sound on pre-exam anxiety among students. Islam and Mental health. 2003;1:113. [Persian].

19- Saeb MR. The comparison between first and last students of university . Islam and Mental health. 2003; 1: 23-5. [Persian].

20- Hill PC, Pargament KI. Advances in the conceptualization and measurement of religion and spirituality: Implications for physical and mental health research. Psychology of Religion and Spirituality, 2008; 1: 3-17.

21- Yi GHH, Bjorck JP. Religious support and psychological functioning in Korean American Protestant Christians. Psychology of Religion and Spirituality. 2014; 6(1): 44-52.

22- Shoaa Kazemi M. The relationship between religious coping strategies and mental health in MS patient. Procedia Soc Behav Sci, 2010; 5:1387–1389.

23- Amrai K, Azizi Zalanihttp://www.sciencedirect.com/science/article/pii/S1877042811003296 H, Sedigh Arfaihttp://www.sciencedirect.com/science/article/pii/S1877042811003296 F, Sharifian MS. The relationship between the religious orientation and anxiety and depression of students. Procedia Soc Behav Sci, 2011; 15: 613–616.

24- Tahmasbipour N, Taheri A. The Investigation of Relationship between Religious Attitude (Intrinsic and Extrinsic) with depression in the university students. Procedia Soc Behav Sci, 2011; 30: 712 – 716.

25- Marashian F, Esmaili E. Relationship between religious beliefs of students with mental health disorders among the students of Islamic Azad University of Ahvaz. Procedia Soc Behav Sci, 2012; 46: 1831 – 1833.

26- Bayani AA, Goodarzi H, Bayani A, Mohammad Koocheki A. The relationship between the religious orientation and anxiety and depression of university students. J Fundam Ment Health. 2008; 10(39): 209-14.

27- Musarezaie A, et al. Relationship between religious orientation, anxiety and depression of students in Isfahan University of Medical Sciences. Behavioural sciences researches. 2011; 10(6): 509-519. [Persian].

28- Nematbakhsh F, Kordi M, Sahebi A, Esmaeeli H. The effect of skinto- skin contact on the severity of postpartum blues of cesarean sectioned women. J Fundam Ment Health. 2004; 6(23):89-98.[Persian].

29- Braam AW, Schaap-Jonker H, Mooi B, de Ritter D, Beekman ATF, Deeg DJH. God image and mood in old age: Results from a community-based pilot study in the Netherlands. Mental Health, Religion & Culture. 2008; 11(2): 221-237.

Received on 17.03.2016 Modified on 25.04.2016

Asian J. Nur. Edu. and Research. 2016; 6(3): 414-418.

DOI: 10.5958/2349-2996.2016.00078.1