Journal of Religion and Health

, Volume 57, Issue 2, pp 596–608 | Cite as

The Factor Structure of the Spiritual Well-Being Scale in Veterans Experienced Chemical Weapon Exposure

  • Hamid Sharif Nia
  • Saeed Pahlevan Sharif
  • Christopher Boyle
  • Ameneh Yaghoobzadeh
  • Bahram Tahmasbi
  • G. Hussein Rassool
  • Mozhgan Taebei
  • Mohammad Ali SoleimaniEmail author
Original Paper


This study aimed to determine the factor structure of the spiritual well-being among a sample of the Iranian veterans. In this methodological research, 211 male veterans of Iran–Iraq warfare completed the Paloutzian and Ellison spiritual well-being scale. Maximum likelihood (ML) with oblique rotation was used to assess domain structure of the spiritual well-being. The construct validity of the scale was assessed using confirmatory factor analysis (CFA), convergent validity, and discriminant validity. Reliability was evaluated with Cronbach’s alpha, Theta (θ), and McDonald Omega (Ω) coefficients, intra-class correlation coefficient (ICC), and construct reliability (CR). Results of ML and CFA suggested three factors which were labeled “relationship with God,” “belief in fate and destiny,” and “life optimism.” The ICC, coefficients of the internal consistency, and CR were >.7 for the factors of the scale. Convergent validity and discriminant validity did not fulfill the requirements. The Persian version of spiritual well-being scale demonstrated suitable validity and reliability among the veterans of Iran–Iraq warfare.


Factor analysis Spiritual well-being Veteran Validity Reliability 



The authors would like to express their gratitude to the patients who participated in this study.

Compliance with Ethical Standards

Conflict of interest

All the authors declare that they have no conflict of interest.


  1. Abbasi, M., Azize, F., Shamsi, E., Naserirad, M., & Akbari, M. (2013). Conceptual and operational definition of spiritual health: A methodological study. Medical Ethics, 6, 11–44.Google Scholar
  2. Akhund, M., & Madarshahian, F. (2004). Effects of physical and mental stress in the lives of war veterans. In: Proceedings of the 6th seminar of the stress-induced diseases, pp. 10–12.Google Scholar
  3. Altimus, C., Ford, W., Chapman, B. & Tillery, C. (2017). The importance of a holistic safety, health, and wellness research program. NIJ Journal.
  4. Avvenuti, G., Baiardini, I., & Giardini, A. (2016). Optimism’s explicative role for chronic diseases. Front Psychol, 7, 295.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Baumgartner, H., & Homburg, C. (1996). Applications of structural equation modeling in marketing and consumer research: A review. International Journal of Research in Marketing, 13, 139–161.CrossRefGoogle Scholar
  6. Brown, J., Hanson, J. E., Schmotzer, B., & Webel, A. R. (2014). Spirituality and optimism: A holistic approach to component-based, self-management treatment for HIV. Journal of Religion and Health, 53, 1317–1328.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Bufford, R. K., Paloutzian, R. F. & Ellison, C. W. (1991). Norms for the spiritual well-being scale. Journal of Psychology and Theology, 19, 56–70.CrossRefGoogle Scholar
  8. Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.CrossRefPubMedGoogle Scholar
  9. Du Gas, B. W. (1983). Introduction to patient care: A comprehensive approach to nursing. Philadelphia, PA: WB Saunders Company.Google Scholar
  10. Ebadi, A., Ahmadi, F., Ghanei, M., & Kazemnejad, A. (2009). Spirituality: A key factor in coping among Iranians chronically affected by mustard gas in the disaster of war. Nursing & Health Sciences, 11, 344–350.CrossRefGoogle Scholar
  11. Elkins, D. N., Hedstrom, L. J., Hughes, L. L., Leaf, J. A., & Saunders, C. (1988). Toward a humanistic-phenomenological spirituality definition, description, and measurement. Journal of humanistic Psychology, 28, 5–18.CrossRefGoogle Scholar
  12. Ellison, C. W. (1983). Spiritual well-being: Conceptualization and measurement. Journal of Psychology and Theology, 11, 330–340.CrossRefGoogle Scholar
  13. Ellison, C. W., & Smith, J. (1991). Toward an integrative measure of health and well-being. Journal of Psychology and Theology, 19, 35–48.CrossRefGoogle Scholar
  14. Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18, 39–50.CrossRefGoogle Scholar
  15. Frueh, B. C., Hamner, M. B., Cahill, S. P., Gold, P. B., & Hamlin, K. L. (2000). Apparent symptom overreporting in combat veterans evaluated for PTSD. Clinical Psychology Review, 20, 853–885.CrossRefPubMedGoogle Scholar
  16. Genia, V. (2001). Evaluation of the spiritual well-being scale in a sample of college students. The International Journal for the Psychology of Religion, 11, 25–33.CrossRefGoogle Scholar
  17. Ghodsbin, F., Safaei, M., Jahanbin, I., Ostovan, M. A., & Keshvarzi, S. (2015). The effect of positive thinking training on the level of spiritual well-being among the patients with coronary artery diseases referred to Imam Reza specialty and subspecialty clinic in Shiraz, Iran: A randomized controlled clinical trial. ARYA Atheroscler, 11, 341–348.PubMedPubMedCentralGoogle Scholar
  18. Gouveia, M. J., Pais-Ribeiro, J. L., & Marques, M. (2012). Study of the factorial invariance of the spiritual well-being questionnaire (SWBQ) in physical activity practitioners’ of oriental inspiration. Psychology, Community & Health, 1, 140–150.CrossRefGoogle Scholar
  19. Hair, J. F., Black, W., Babin, B., & Anderson, R. (2010). Multivariate data analysis (7th ed.). Upper Saddle River, NJ: Prentice Hall.Google Scholar
  20. Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2013). Multivariate data analysis. London: Pearson Education Limited.Google Scholar
  21. Hajloo, N. (2009). Relationship between economic-social activity and reduction of veterans’ psychological problems. Journal of Military Medicine, 11, 89–95.Google Scholar
  22. Hall, T. W., & Edwards, K. J. (1996). The initial development and factor analysis of the Spiritual Assessment Inventory. Journal of Psychology and Theology, 24, 233–246.CrossRefGoogle Scholar
  23. Harrington, D. (2008). Confirmatory factor analysis. USA: Oxford University Press.CrossRefGoogle Scholar
  24. Hashemian, S. A., & Khademi, M. J. (2015). The survey of veterans’ mental health based on spiritual well-being and life satisfaction. Journal of Military Medicine, 16, 205–209.Google Scholar
  25. Herth, K. (2000). Enhancing hope in people with a first recurrence of cancer. Journal of Advanced Nursing, 32, 1431–1441.CrossRefPubMedGoogle Scholar
  26. Hojjati, H., Motlagh, M., Nouri, F., Shirifnia, S. H., Mohammadnejad, E., & Heydari, B. (2010). Relationship between different dimensions of prayer and spiritual health of patients treated with hemodialysis. Iranian Journal of Critical Care Nursing, 2, 7–8.Google Scholar
  27. Hooper, D., Coughlan, J., & Mullen, M. (2008). Structural equation modelling: Guidelines for determining model fit. Electronic Journal of Business Research Methods, 6, 53–60.Google Scholar
  28. Ismail, H., Wright, J., Rhodes, P., & Small, N. (2005). Religious beliefs about causes and treatment of epilepsy. British Journal of General Practice, 55, 26–31.PubMedPubMedCentralGoogle Scholar
  29. Jiang, W. (2014). Business partnerships and organizational performance: The role of resources and capabilities. Berlin Heidelberg: Springer.CrossRefGoogle Scholar
  30. Kellar, S. P., & Kelvin, E. A. (2012). Munro’s statistical methods for health care research. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.Google Scholar
  31. Khorami, M., Yaghmaei, F., Khodayari Fard, M., Didarloo, A. R., & Mokhtari, L. (2014). Psychometric charactristics of the spiritual well-being scale in oncology nurses. Journal of Urmia Nursing And Midwifery Faculty, 12, 935–942.Google Scholar
  32. Kumar, C. S., & Parashar, N. (2015). Death anxiety, coping and spirituality among cancer patients. Indian Journal of Positive Psychology, 6, 291–294.Google Scholar
  33. Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.CrossRefPubMedGoogle Scholar
  34. Ledbetter, M. F., Smith, L. A., Fischer, J. D., Vosler-Hunter, W. L., & Chew, G. P. (1991). An evaluation of the construct validity of the Spiritual Well-Being Scale: A confirmatory factor analytic approach. Journal of Psychology and Theology, 19, 94–102.CrossRefGoogle Scholar
  35. Livneh, H., Lott, S., & Antonak, R. (2004). Patterns of psychosocial adaptation to chronic illness and disability: A cluster analytic approach. Psychology, Health & Medicine, 9, 411–430.CrossRefGoogle Scholar
  36. Lou, V. W. (2015). Spiritual well-being: An introduction. Spiritual well-being of Chinese older adults. New York: Springer.CrossRefGoogle Scholar
  37. Lyon, M. E., Jacobs, S., Briggs, L., Cheng, Y. I., & Wang, J. (2014). A longitudinal, randomized, controlled trial of advance care planning for teens with cancer: Anxiety, depression, quality of life, advance directives, spirituality. Journal of Adolescent Health, 54, 710–717.CrossRefPubMedGoogle Scholar
  38. Mahbobi, M., Etemadi, M., Khorasani, E., & Ghiasi, M. (2012). The relationship between spiritual health and social anxiety in chemical veterans. Journal of Military Medicine, 14, 186–191.Google Scholar
  39. Masoumi, M., Soroush, M. R., & Modirian, E. (2008). Evaluation of psychiatric problems among war-related bilateral upper limb amputees. Journal of Military Medicine, 10, 185–192.Google Scholar
  40. Miller, G., Gridley, B., & Fleming, W. (1998). Spiritual well-being scale ethnic differences between caucasians and African-Americans: Follow up analyses. Journal of Psychology and Theology, 26, 358–364.CrossRefGoogle Scholar
  41. Moghimiyan, M., Salmani, F., & Azarbarzin, M. (2011). Relationship of test anxiety and spiritual well-being in nursing student. Journal of Qom University of Medical Science, 5, 31–36.Google Scholar
  42. Munro, B. H. (2005). Statistical methods for health care research. Philadelphia, PA: Lippincott Williams & Wilkins.Google Scholar
  43. Musa, A. S., & Pevalin, D. J. (2012). An Arabic version of the spiritual well-being scale. International Journal for the Psychology of Religion, 22, 119–134.CrossRefGoogle Scholar
  44. Nabatian, E., Ghamarani, A., Zakerian, M., & Mahdizadeh, I. (2013). relationship between Spiritual health with quality of life veterans and disabled Birjand. Iranian Journal of War and Public Health, 5, 35–39.Google Scholar
  45. Paloutzian, R. F., & Ellison, C. W. (1991). Manual for the spiritual well-being scale (Vol. 9, pp. 35–48). Nyack, NY: Life Advance.Google Scholar
  46. Rahimi, C., & Smael Tabar, M. (2007). Assessment of aggression and maladaptive behaviors in veterans with PTSD caused by the war. In Proceedings of the 4th symposium on the prevention and treatment of neurological complications, psychological effects of war, pp. 12–13.Google Scholar
  47. Raoprasert, T., & Islam, S. M. N. (2010). Designing an efficient management system: Modeling of convergence factors exemplified by the case of Japanese businesses in Thailand. Heidelberg: Physica-Verlag HD.CrossRefGoogle Scholar
  48. Rasmussen, H. N., Scheier, M. F., & Greenhouse, J. B. (2009). Optimism and physical health: A meta-analytic review. Annals of Behavioral Medicine, 37, 239–256.CrossRefPubMedPubMedCentralGoogle Scholar
  49. Rezaei, M., Seyedfatemi, N., & Hosseini, F. (2009). Spiritual well-being in cancer patients who undergo chemotherapy. Hayat, 14, 33–39.Google Scholar
  50. Rezaie Shahsavarloo, Z., Lotfi, M., Taghadosi, M., Mousavi, M., Yousefi, Z., & Amirkhosravi, N. (2015). Relationship between components of Spiritual well-being with hope and life satisfaction in elderly cancer patients in Kashan, 2013. Iranian Journal of Geriatric Nursing, 1, 43–54.Google Scholar
  51. Saggino, A., & Kline, P. (1996). Item factor analysis of the Italian version of the Death Anxiety Scale. Journal of Clinical Psychology, 52, 329–333.CrossRefPubMedGoogle Scholar
  52. Sayers, S. L., Farrow, V. A., Ross, J., & Oslin, D. W. (2009). Family problems among recently returned military veterans referred for a mental health evaluation. Journal of Clinical Psychiatry, 70, 163–170.CrossRefPubMedGoogle Scholar
  53. Sb, J., & Gudaganavar, N. (2011). Effect of varying sample size in estimation of reliability coefficients of internal consistency. Webmed Central [Internet]. 2011 Feb 23 [cited 2011 Dec 22].Google Scholar
  54. Schreiber, J. B., Nora, A., Stage, F. K., Barlow, E. A., & King, J. (2006). Reporting structural equation modeling and confirmatory factor analysis results: A review. Journal of Education Research, 99, 323–338.CrossRefGoogle Scholar
  55. Scott, E. L., Agresti, A. A., & Fitchett, G. (1998). Factor analysis of the ‘Spiritual Well-Being Scale’ and its clinical utility with psychiatric inpatients. Journal for the Scientific Study of Religion, 37, 314–321.CrossRefGoogle Scholar
  56. Sharif Nia, H., Ebadi, A., Lehto, R. H., & Peyrovi, H. (2015a). The experience of death anxiety in Iranian war veterans: A phenomenology study. Death Stud, 39, 281–287.CrossRefPubMedGoogle Scholar
  57. Sharif Nia, H., Ebadi, A., Lehto, R. H., Mousavi, B., Peyrovi, H., & Chan, Y. H. (2014). Reliability and validity of the persian version of templer death anxiety scale-extended in veterans of Iran–Iraq warfare. Iranian Journal of Psychiatry and Behavioral Sciences, 8, 29–37.PubMedPubMedCentralGoogle Scholar
  58. Sharif Nia, H., Haghdoost, A. A., Ebadi, A., Soleimani, M. A., Yaghoobzadeh, A., Abbaszadeh, A., et al. (2015b). Psychometric properties of the king spiritual intelligence questionnaire (KSIQ) in physical veterans of Iran–Iraq warfare. Journal of Military Medicine, 17, 145–153.Google Scholar
  59. Sharif Nia, H., Pahlevan Sharif, S., Goudarzian, A. H., Haghdoost, A. A., Ebadi, A., & Soleimani, M. A. (2016). An evaluation of psychometric properties of the Templer’s Death Anxiety Scale-Extended among a sample of Iranian chemical warfare veterans. Hayat, 22, 229–244.Google Scholar
  60. Shawn, O. U., Angela, L., Mark, A. B., & Yzette, L. (2005). A confirmatory test of the factor validity of scores on the spiritual well-being scale in a community sample of African Americans. Journal of Psychology and Theology, 33, 251–257.CrossRefGoogle Scholar
  61. Soleimani, M. A., Pahlevan Sharif, S., Allen, K. A., Yaghoobzadeh, A., Sharif Nia, H. & Gorgulu, O. (2016). Psychometric properties of the persian version of spiritual well-being scale in patients with acute myocardial infarction. Journal of Religion and Health. doi: 10.1007/s10943-016-0305-9.
  62. Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics. London: Pearson Education.Google Scholar
  63. Taheri-Kharameh, Z., Abdi, M., Omidi Koopaei, R., Alizadeh, M., Vahidabi, V., & Mirhoseini, H. (2016). The relationship between religious-spiritual well-being and stress, anxiety, and depression in university students. Health, Spirituality and Medical Ethics, 3, 30–35.Google Scholar
  64. Unterrainer, H.-F., Nelson, O., Collicutt, J., & Fink, A. (2012). The English version of the multidimensional inventory for religious/spiritual well-being (MI-RSWB-E): First results from British College Students. Religions, 3, 588.CrossRefGoogle Scholar
  65. Vella-Brodrick, D. A., & Allen, F. C. (1995). Development and psychometric validation of the Mental, Physical, and Spiritual Well-Being Scale. Psychological Reports, 77, 659–674.CrossRefPubMedGoogle Scholar
  66. Walter, S. D., Eliasziw, M., & Donner, A. (1998). Sample size and optimal designs for reliability studies. Statistics in Medicine, 17, 101–110.CrossRefPubMedGoogle Scholar
  67. You, S., & Yoo, J. E. (2016). Evaluation of the spiritual well-being scale in a sample of Korean adults. Journal of Religion and Health, 55, 1289–1299.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Hamid Sharif Nia
    • 1
  • Saeed Pahlevan Sharif
    • 2
  • Christopher Boyle
    • 3
  • Ameneh Yaghoobzadeh
    • 4
  • Bahram Tahmasbi
    • 1
  • G. Hussein Rassool
    • 5
  • Mozhgan Taebei
    • 6
  • Mohammad Ali Soleimani
    • 7
    Email author
  1. 1.School of Nursing and Midwifery AmolMazandaran University of Medical SciencesSariIran
  2. 2.Taylor’s Business SchoolTaylor’s University MalaysiaSubang JayaMalaysia
  3. 3.Graduate School of EducationUniversity of ExeterExeterUK
  4. 4.Tehran University of Medical SciencesTehranIran
  5. 5.University of São Paulo at Ribeirão Preto College of Nursing - WHO Collaborating Centre for Nursing Research DevelopmentJundiaíBrazil
  6. 6.School of Nursing and Midwifery RaziKerman University of Medical SciencesKermanIran
  7. 7.Social Determinants of Health Research CenterQazvin University of Medical SciencesQazvinIran

Personalised recommendations