COVID-19 related stress, quality of life, and intrinsic religiosity among college students during the global pandemic: A cross-sectional study

Abstract

The purpose of this correlational, cross-sectional design study was to examine the relationships between COVID-19-related stress, quality of life (QOL), and intrinsic religiosity of university students during the pandemic. Data were collected using the Psychological General Well-being Index, Impact of Events Scale-Revised, and Duke University Religiosity Index and analyzed using bivariate and hierarchical regression analyses, and hierarchical regression analysis. For the sample of 422 participants, COVID-19-related stress was negatively associated with QOL, while religiosity was positively associated with participants’ QOL. Religiosity, however, did not moderate the relationship between stress and QOL. Institutions of higher education should consider providing additional mental health support and self-care initiatives to improve student stress responses. Understanding the effects of religiosity on student stress responses and QOL would allow faculty and institutions to prioritize holistic care, including spiritual care in conjunction with religiosity.

Keywords:

• stress
• anxiety
• quality of life
• QOL
• mental health
• COVID-19
• religiosity

1.

The recent COVID-19 pandemic led to lockdowns, college closures, delays, and alterations in learning modality resulting in adverse physical and psychological impacts on college students (Joseph et al., 2021). Common stressors included fear of infections in self and in family members who work in health care, lack of personal protective equipment, failure to thrive in classes, delays in graduation, financial constraints, and difficulty obtaining a job or transiting effectively (Lovrić et al., 2020). Reports of increased substance use, suicide, and depression among young adults increased while mental health support was less available in general, and closures of college campuses made resources unavailable to students. Students who used the internet scantily before the pandemic were found to be more prone to loneliness during the pandemic than those who used the internet regularly prior to the pandemic (Erol & Cirak, 2019). Adaptation to the environment, social support, and optimal management of stress were found to enhance the mental health of nursing students in China (Li et al., 2021).

Globally, the pandemic has affected students in several ways. Kaparounaki et al., (2020) reported increased depression, anxiety, and suicidal ideations and a worsening quality of sleep and quality of life (QOL) in college students in Greece. In Italian universities, students expressed difficulty concentrating and sleeping, increased sadness, eating disorders, and irritability, and experienced increased tachycardia and negative feelings (Commodari et al., 2021). Understanding the multiple dimensions of student mental health proved foundational to supporting medical students (Concerto et al., 2022). The aim of this study was to extend the literature by examining the relationship between QOL, COVID-19-related stress, and religiosity among college students, which would provide new insight in how to support them during and in the aftermath of the global pandemic.

2. Quality of life

Quality of life is a complex concept that involves both physical, mental, and spiritual components which are essential for optimal functioning and the maintenance of healthy relationships. As most college students are young adults and are exploring a career or family, competing responsibilities may emerge along with their pursuit of a good education. This complexity may increase when a crisis like a pandemic occurs. Students’ stress, anxiety, depression, positive well-being, self-control, general health, vitality, and feeling of loneliness may be affected. However, their faith and religiosity may be mitigating factors.

The research on the mental health and wellbeing of university students during the COVID-19 pandemic suggests students are in crisis (Chen & Lucock, 2022). The typical 18 to 25-year-old university student usually struggles with the internal and parental pressure of academic excellence and external social pressures (Popovic & Lim, 2020). If a typical college student fails to fit in, even without additional COVID-19 related stressors, the situation may result in anxiety, depression, disengagement, increased alcohol/substance abuse, and suicidal ideation (de Paula et al., 2020). In such a context, the stressor of a pandemic can result in crisis. Italian students (ages 18–30) reported worse depressive symptoms during lockdown than six months before isolation, and surprisingly, students without an established diagnosis of psychopathology were more affected than students with established psychopathology (Meda et al., 2021). Son et al. (2020) found that 71% of 195 students from a large United States (U.S.) public institution indicated an increase in stress and anxiety based on multiple stressors (e.g. fear of infection, fear of loved ones contracting COVID-19, difficulty in academic concentration, disruptions in sleep patterns, isolation, fear of academic decline). Of the 1535 students in Greece, 12.43% reported major depressive symptoms and 13.46% reported severe distress during COVID-19 (Patsali et al., 2020). The mental health crisis is significant to diagnose and treat during times of traumatic life events such as COVID-19.

Not only did isolation, stress, and increased depression symptoms affect the mental health concerns of college students, the change in the mode of instruction during COVID-19 also increased stress. The new online classroom instruction format increased self-awareness, Zoom fatigue, lack of motivation, time management issues, and increased screen time in “quarantine” which all seemed to fuel more anxiety in college students (Degges-White, 2020b). Physical, emotional, and social exhaustion from sequential online meetings, sickness, death in families and life management challenges resulted in increased stress (Degges-White, 2020a). Although previously diagnosed depressed students have shown some increase in symptoms during COVID-19, it should be noted that more “suspected healthy” students have been impacted by depressive symptoms as reported by (Meda et al., 2021). Another study reported a three-fold increase in possible clinical cases of depression and an almost eight-fold increase in suicidal thoughts during the COVID-19 lockdown in Greece (Kaparounaki et al., 2020). Such change in QOL could explain the drop in collegiate admissions during the 2021 academic year.

College admissions in the U.S. are down by 5.6% (Whitford, 2021), and according to education data, the number of graduate students declined by 27.9%, and undergraduates decreased by 5.1% in 2021 (Hanson, 2021). The Brazilian college entrance examination has 44% fewer applicants (Jaschik, 2021). The number of new international students in U.S. universities dropped by 45.6% in 2021 compared to previous years (Moody, 2021). According to Gaebel and Stoeber (2021), in a survey of European universities, most universities did not find a change in enrollment or attrition of the domestic student population; however, a decrease in international student enrollment was noted. Clear data from other continents are not available currently, except the exploration on problems experienced by the students who seek education abroad. Thus, the life plans of aspiring college students changed globally, possibly altering their mental and emotional health and wellness. However, students who are religious may find hope and maintain their QOL.

College students have many internal and external factors that influence QOL. Academic stress and COVID-19–related anxiety negatively impact QOL in Filipino nursing students (Berdida & Grande, 2021). A subset of university or college students, nursing students, who face intense academic stressors, expressed magnified anxiety levels during the pandemic (Grande et al., 2022), yet resilience was found to be a significant mediating factor on QOL (Berdida & Grande, 2023). While resilience was not a focus of this study, resilience has been associated with religiosity.

2.1. Religiosity and spirituality of college students

Defining religiosity and spirituality is a challenge, and no gold standard definition is available (Reinert & Koenig, 2013). While defining religiosity and spirituality is challenging, researchers agree that both are intertwined but distinctly different (Akers & Miller, 2023). Religiosity is linked to a founder or group of founders, formal traditions, codes of behavior or practices, and proselytization (Schneiders, 2003); however, spirituality is a very personal experience (Tanyi, 2002), filled with intrinsic value and may not be affiliated with a formal religion (Schneiders, 2003). External acts of religion may be the expressed effects of internal spirituality (Akers & Miller, 2023). The lens through which one views the world around and one’s placement within it is often guided by one’s spirituality or religiosity.

While religiosity may be expressed in external actions and behaviors, religiosity can be deeply internal as well. Intrinsic religiosity is the application of one’s religious beliefs as a “framework” for daily life (Masters, 2013). Intrinsic religiosity is expressed when one considers their whole life founded upon their religion and makes decisions based upon their religious beliefs.

Religiosity and spirituality create nuanced differences in one’s perception of experiences, including college campus life (Fosnacht & Broderick, 2020), and create a sense of purpose (Fuertes & Dugan, 2021). The more students believed their religious/spiritual beliefs were respected and the more freedom they felt to express their religious/spiritual beliefs, the higher they ranked school support and quality interactions (Fosnacht & Broderick, 2020). In a time of crisis, such as the COVID-19 pandemic, students need holistic support from faculty and academic institutions.

While spirituality is personal and fluid, holistic student support includes the diverse religious/spiritual components of each student (Fuertes & Dugan, 2021). Spirituality and religiosity impact the support needed whether the student is domestic (Bland et al., 2012) or international (Philip et al., 2019), both of which bring multiple life stressors to their college experience even before the impact of the COVID-19 pandemic. Educators and higher education administrators should consider how to positively support students’ religious/spiritual needs.

2.2. Purpose

The purpose of this study was to examine the impact of COVID-19 on college students at all program levels at institutions primarily in the U.S. about COVID-19 related stress (Impact of Events Scale-Revised; IES-R), religiosity (Duke University Religion Index; DUREL), and Psychological General Wellbeing (Psychological General Wellbeing Index; PGWBI). Such first-hand information about the experience of college students during COVID-19 could help faculty and administrators develop strategies to address student concerns and provide resources.

Therefore, the researchers asked the following questions.

1. Is there a negative relationship between COVID-19 related stress (IES-R) and QOL indicators (anxiety, depressed mood, positive well-being, self-control, general health, and vitality subscales from the PGWBI) among college students during the global pandemic?

2. Is there a positive relationship between religiosity and QOL indicators among college students during the global pandemic?

3. Does religiosity (DUREL) buffer the negative relationship between COVID-19 related stress and participants’ overall QOL (PGWBI)?

Understanding which areas of psychological well-being was impacted by COVID-19 would provide valuable information for researchers, mental health care providers, and educators. Also, a previous single-site qualitative study early during the pandemic indicated that students were engaged in spiritual and religious activities to cope with effects of the pandemic with the majority of the students using religious behaviors, such as prayer, bible study, and worship, to cope with the COVID-19 related stress (Joseph et al., 2022). For this current, broader study, the authors used psychometrically sound measures to study the relationship between COVID-19 related stress, QOL indicators, and religiosity. The authors hypothesized a significant negative association between COVID-19 related stress and QOL indicators (hypothesis one). The authors also hypothesized that intrinsic religiosity would be positively associated with QOL indicators during the global pandemic (hypothesis two). Finally, the authors hypothesized that the negative link between participants’ COVID-19 related stress and overall QOL would be buffered by their intrinsic religiosity (hypothesis three).

3. Methods

3.1. Design

A cross-sectional design was used to explore the impact of COVID-19 on higher education students. A survey was developed in Qualtrics to include demographic data and quantitative data using the Impact of Events Scale-Revised (IES-R), Duke University Religiosity Index (DUREL), and Psychological General Well Being Index (PGWBI). The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) (Eysenbach, 2004) was used to guide participant recruitment, ethical considerations, data collection, and data analysis.

3.2. Sample, setting, recruitment

Convenience sampling provided participants who were recruited from all program levels in higher education. Several universities were invited to participate via email. Additionally, we invited participation through social media. The survey link was shared with students within the investigators’ university and other universities through their administration. Data were collected between March 2021 and September 2021, approximately one year after the emergence of the pandemic in the U.S. Inclusion criteria consisted of being a College/University student, full-time or part-time, undergraduate or graduate, being 18 years or older, and willingness to participate.

A total of 828 began the survey, while only 422 students participated in the survey in its entirety (51%). The additional 406 participants who started but failed to complete the survey were excluded from the data. Of the remaining 422 participants, 49.1% (n = 207) were between the ages of 18–25, 18.5% between 26–35, 21.6% between 36–50, and 10.7% above 50; one did not report age. Most of the participants were female (n = 365; male n = 54), and the majority were white/Caucasian (74.9%), with 7.3% Latino/Hispanic, 5% Black/African American, 5% Asian/Asian American, and 7.8% other. Most participants were Christian (Protestant, 32.7%, Christian-other 29.9%, and Catholic 15.2%). Of the total number of participants, 65.9% (n = 278) reported that their institution was faith-based. Most of the participants were classified as undergraduate (62.1%, n = 262), while 37.4% (n = 158) were graduate (2 did not report). Participants were mostly fulltime residential (46.4%, n = 196) (30.8% full-time online, 19% part-time online, 3.1% full-time online, and 6% undeclared). About 44.8% (n = 189) of the participants reported that their institution was fully online since the beginning of the pandemic. Participants included those from the United States (n = 405, 95.9%), India (n = 12, 3%), Jordan (n = 4.0.9%), and Uganda (n = 1, 0.2%).

Though challenges exist with online surveys, participation was adequate with 422 completed surveys. Participants completed the survey within an average of 46 minutes. Incomplete surveys were not included in the study, nor were incomplete participants contacted again. No duplicated IP addresses were noted. No incentives were offered for participation.

3.3. Ethical considerations

The University IRB approved the study (IRB-FY20-21-739). All participation was voluntary and involved minimal risk. Consent was obtained prior to the participation as part of the anonymous online survey using Qualtrics, and all data were digitally stored and password protected. Some universities required their IRB involvement, to which we complied.

3.4. Instruments

In addition to general demographic data, the IES-R was used as a measure of COVID-19 related stress, which is a 22-item five-point Likert scale (from 0 = “Not at all” to 4 = “Extremely”) with a score range of 0 to 88 (Christianson & Marren, 2012; Weiss, 2007). This measure has three subscales: hyperarousal (eight items), avoidance (eight items), and intrusion (six items). The IES-R scores are categorized into four post-traumatic stress disorder (PTSD) levels: 0 to 23 for non-PTSD, 24 to 32 for low-risk PTSD, 33 to 36 for a probable diagnosis of PTSD, and≥37 for high-risk PTSD. High-risk PTSD represents a stress level which can suppress the immune system up to 10 years post-event. The scale is one of the most widely used screening tools for PTSD and has high levels of internal consistency in each of the three clusters: hyperarousal (α = .79–.91), intrusion (α = .87–.94), and avoidance (α = .84–.87). Weiss and Marman (2007) reported test reliability of .89–.94 across a six-month interval. (Cash et al., 2008) found the IES-R internal reliability to be high among total scores (α = .95). The IES-R is a public domain instrument. For this sample, internal consistency reliability was high with the Cronbach’s alpha of .95.

The DUREL was developed in 1997 to determine the effect of religiosity on healthcare outcomes Koenig & Bussing, 2010. The DUREL consists of five self-report items, using a Likert scale, that assesses three major dimensions of religious activity: (a) organizational religious activities, (b) private religious activities, and (c) intrinsic religiosity. In this study, we used the 3-item intrinsic religiosity subscale (items 3–5) only (DUREL-IR) because we wanted to examine the role of religiosity as having psychological impacts on participants, not organized or non-organized religious activities. Participants responded to each item on a scale of 1–5, making the total score range from 3–15, in which higher scores indicate higher levels of intrinsic religiosity. Internal consistency was demonstrated by a Cronbach’s alpha between .78 and .91, and the test-retest for reliability demonstrated a correlation coefficient of .91 (Koenig & Bussing, 2010; Lucchetti et al., 2012). Written permission was obtained from the scale developer, allowing the use of this tool for this research. For this sample, internal consistency reliability for the intrinsic religiosity subscale was adequate with an alpha of .94.

The PGWBI was originally developed by Dupuy and later revised in collaboration with the RAND Corporation into its final form using a standardized Likert scale with six points (Grossi & Compare, 2014). The PGWBI is a 22-item survey measuring the level of subjective psychological well-being. A high score on the PGWBI is indicative of high levels of psychological well-being. Six affective states are assessed within six subscales: anxiety, depressed mood, positive well-being, self-control, general health, and vitality. When completed, the tool produces a single measure of well-being with internal consistency (Cronbach’s Alpha) ranging from 0.89 to 0.96 when tested across multiple countries (Marquis & Dubois, 1997). The PGWBI is a public domain instrument. For this sample, internal consistency reliability was high with an alpha of .95. Alphas for the subscales were all adequate (αs = .68–.89).

4. Results

Data were analyzed using bivariate and hierarchical regression analyses. There was no serious skewness or kurtosis problem for IES-R (skewness = .70; kurtosis = −.27) and PGWBI (skewness = −.21; kurtosis = −.85). DUREL-IR (skewness = −1.07; kurtosis = −.19), showed left skewness, indicating a more intrinsically religious sample in our data, but it was still within the acceptable range of |2|. Using G*Power software, a power analysis was conducted. For a multiple regression analysis with three predictors (including the interaction term for the moderation analysis in our study), a sample size of 77 was required to have 80% statistical power with an alpha level of .5 and a medium effect size of f² = .15. With a sample of 422, ample statistical power was achieved in this study.

Hypotheses one and two were that there would be a negative relationship between COVID-19 related stress and QOL indicators and a positive relationship between religiosity and QOL indicators. Participants’ overall QOL measured based on the total scores of the PGWBI was positively associated with religiosity (r = .28, p < .01) and negatively associated with COVID-19 related stress (r = −.57, p < .01). Religiosity was negatively associated with COVID-19 related stress (r = −.19, p < .01). Upon the examination of the QOL indicators, namely, anxiety (Anx), depression (Dep), positive well-being (PWB), self-control (SC), general health (GH), and vitality (VT), their relationship with other study variables were significantly related in the predicted directions at the p level of below .01, showing that religiosity and QOL, in general, have a positive relationship and that COVID-19 related stress and QOL, in general, have a negative relationship as expected. Effect sizes based on the r coefficients were stronger for the link between COVID-19 related stress and QOL indicators than the link between religiosity and QOL indicators. See Table 1 for means, standard deviations, and correlations of all study variables.

Table 1. Mean (M), standard deviation (SD), internal consistency reliability (alpha), and correlations for all main study variables

Measures	1	2	3	4	5	6	7	8	9
1. IES-R	1
2. DUREL-IR	−.18**	1
3. PGWBI	−.60**	.31**	1
4. ANX	.57**	−.27**	−.90**	1
5. DEP	.50**	−.28**	−.82**	−.75**	1
6. PWB	−.48**	.30**	.87**	.70**	.74**	1
7. SC	−.51**	.23**	.82**	.71**	.69**	.67**	1
8. GH	−.48**	.18**	.71**	.58**	.54**	.52**	.52**	1
9. VT	−.49**	.29**	.86**	.70**	.67**	.75**	.60**	.56**	1
M	43.86	22.04	65.00	13.03	11.74	10.60	9.69	10.05	9.92
SD	18.00	7.00	20.79	5.74	4.05	4.04	3.14	3.03	4.49
Alpha	.95	.94	.95	.89	.83	.76	.70	.68	.87

Note. IES-R—COVID-related stress, DUREL-IR = Intrinsic Religiosity, PGWBI = Psychological General Well-being Index, ANX = Anxiety, DEP = Depression, PWB = Positive Well-Being, SC = Self-control, GH = General Health, and VT = Vitality (VT). For the PGWBI subscales, all negatively keyed items were recoded so that higher scores indicate higher well-being. For instance, higher ANX scores indicate lower anxiety. **p < .01.

Researchers further hypothesized that intrinsic religiosity would moderate the relationship between participants’ COVID-19 related stress and overall QOL (hypothesis three). To answer hypothesis three, we ran a hierarchical regression analysis. We used PGWBI (the overall QOL) as a criterion variable and entered predictor variables in the following order: 1) Step 1: Religiosity (DUREL) and COVID-19 related stress (IES-R), and 2) Step 2: The interaction term of DUREL and IES-R to see whether the effect of COVID-19 related stress depended on or was moderated by religiosity.

In Step 1, both religiosity (β = .17, p < .001) and COVID-19 related stress (β = −.57, p < .001) uniquely contributed to participants’ overall QOL, which, when combined, explained about 39% of the total variance in overall QOL (R² = .39, F (2, 419) = 132.08, p < .001).

Adding the interaction term to check the moderating role of religiosity did not significantly improve the model (∆R² = .00, Fchange (1, 418) = 1.81, p = .179). These findings suggest that while religiosity is a significant predictor of QOL during the global pandemic, explaining unique variances in QOL, religiosity does not attenuate the negative link between COVID-19 related stress and QOL. See Table 2 for the results from the hierarchical regression analysis.

Table 2. Hierarchical multiple- regression analysis

Predictors
Criterion Variable: PGWBI
		R^2	β	ΔR^2
Step 1		.39		.39***
	IES-R		−.57***
	DUREL-IR		.17***
Step 2		.39		.00(ns)
	IES-R		−.69***
	DUREL-IR		.07**
	IES-R*DUREL-IR		.16(ns)

Note. IES-R—COVID-related stress, DUREL-IR = Intrinsic Religiosity, PGWBI = Psychological General Well-being Index as a measure of quality of life (QOL). **p < .01.*** p < . 001. ns = no significant.

5. Discussion

Four hundred and twenty-two students from institutions of higher education from within (n = 405) and outside (n = 17) the U.S. completed the survey examining the stress, QOL, and religiosity of students subsequent to the pandemic. The majority were from within the U.S. and all regions of the country were well represented. Participants outside the U.S. were from India (n = 12), Jordan (n = 4), and Uganda (n = 1). Residential and online students were similar in numbers, and most students claimed they were from faith-based institutions although that factor may not reflect individual religiosity.

In this study, we found that about 60% of the participants were suffering from at least some level of COVID-19 related stress (as opposed to 40% with no stress) and about 22% were struggling with a high risk of COVID-19 related stress. It has been known that stress can result in altered QOL (Berdida & Grande, 2021; Ribeiro et al., 2018). It is not different for college students of any age. Different countries defined and identified sources of stress related to COVID-19 differently. Quarantine of varying duration and timelines might have contributed to some of these. (Son et al., 2020) reported the negative effect of lockdown in college students in the U.S. Pakistani students reported stress associated with online teaching, concerns about academic success and course completion, and moving forward in their college or career, uncertainty related to exam dates, and the status of the following semester (Baloch et al., 2021). A high prevalence of mental health concerns among college students was reported from different countries such as France (Wathelet et al., 2020), Malaysia (Sundarasen et al., 2020), and China (Ma et al., 2020).

A systematic review found that the QOL was frequently negatively associated with stress and can result in disruption of sleep patterns and burnout (Ribeiro et al., 2018). Such severe burnout can result in severe mental health issues which can result in suicides, particularly in service professions (Wan, 2021). Mental health issues were already on the rise with diminishing services even prior to the pandemic, which can result in health issues and academic failure (Wahed & Hassan., 2018). The QOL of students is also affected by socioeconomic, demographic, and behavioral factors (Nur et al., 2017). While COVID-19 triggered independent learning, a higher motivation is critical for learning success in distant education, whereas low motivation may lead to maladaptive behavior like procrastination (Holzer et al., 2021). To summarize, research supports students’ adaptation could be based on high motivation, and good stress management tools. However, research is limited on how impactful religiosity has been on those dealing with COVID-19.

We found that religiosity and well-being, generally, have a positive correlation (hypotheses one) and the students perceived less stress related to the pandemic (Table 2). Koenig (2020) reported that religious faith and practice can play a pivotal role in protecting individuals from infection and that the “fruit of the spirit” (love, joy, peace, forbearance, kindness, goodness, faithfulness, gentleness, and self-control; Galatians 5:22–23) can be protective. These authors validate their previous finding that scriptures and meditation can benefit immune system function. They also advocate for deepening their religious faith, loving their neighbors, staying connected with technology, serving their neighbors, caring for self, and paying attention to physical health by engaging in proper exercise, sleep, dietary intake, hydration, and weight control. Overall, our findings concur with those of Koenig (2020).

It was hypothesized that the intrinsic religiosity of students would predict the overall QOL while controlling for stress (hypotheses two). As indicated earlier, religiosity uniquely contributed to the participants’ overall QOL while controlling for COVID-19 related stress (Table 3). (Duffy et al., 2012) found that religiosity is a determinant of undergraduate students’ life satisfaction. The students would likely reflect their career as a calling which would give meaning to their academic domain. However, Tanyi (2002) and Schneiders (2003) describe spirituality as a very personal experience which has intrinsic value and may not be affiliated with a religion. Felicilda-Reynaldo et al., (2019) found that organized and non-organized religious activities led nursing students to improved physical and psychological health and overall QOL, which our study outcomes further support. In highly stressful situations, such as the frequently changing expectations on the education system resulting from COVID-19, students who have high religiosity may experience a higher QOL.

We also hypothesized that intrinsic religiosity could buffer the effect of the participants’ COVID-19 related stress on their overall QOL (hypothesis three). While adding the interaction term (IES-R religiosity) did not make a noticeable change in the R², religiosity was associated with the overall PGWBI scores and all of the subscales of PGWBI (Table 2). Religiosity has been linked to statistically significant decreases in moderate to high depression (p < .001), anxiety (p < .001), and stress (p < .01) (Kim et al., 2021). During times of crisis, such as the COVID-19 pandemic, people rely on religion, religious activities, and spiritual beliefs to reduce both stress and stress-related injuries (Rafati et al., 2017). Therefore, while the specific hypothesis of the moderating role of religiosity was not supported, mental health and QOL benefits may still occur if religiosity is an important part of an individual’s life, especially during challenging times.

Given the high religiosity level among the sample as well as the correlational findings, researchers speculate that perhaps the participants in this study may have higher resilience shown by positive adaptation during the COVID-19 pandemic, and that this higher resilience may have been in fact due to religiosity levels. Resilience was not assessed in this study; however, religiosity has been shown to impact resilience. Schwalm et al.'s (2022) review reported a moderate positive correlation between religiosity/spirituality and resilience (r = 0.40(95% CI, 0.32–0.48], p < 0.01). Religiosity was positively associated with resilience in several studies such as patients with breast cancer (Fradelos et al., 2018) and depression (Mosqueiro et al., 2015), both stressful life events. Edara et al., (2021) reported a positive impact of religiosity on resilience and wellness in Taiwanese University Students during the COVID-19 pandemic. In contrast, Gan et al., (2023) showed a positive correlation between religiosity and well-being, signifying that religion may support an overall sense of well-being, and indicated resilience was also correlated with a positive sense of well-being. However, resilience was not statistically significantly predicted by religiosity (Gan et al., 2023). Given the mixed findings, further research is warranted to assess the relationship between religiosity and resilience in college students facing challenging situations and further explore in what ways religiosity might be beneficial.

6. Implications

The overall findings indicate the mean stress scores are high in college students. Students need physical, emotional, spiritual, and social support to get through this crisis. The American Medical Association (AMA) recounted the efforts reported by health care organizations to manage the stress and burnout in health care workers, such as peer support groups, one-on-one consultations, crisis support lines and programs to support basic needs (AMA, 2020). Faculty and staff could facilitate and encourage self-care services to students at all levels. Mental health services on campus must be enhanced to support the increasing needs of the students during and following the pandemic. Faculty, who understand physical, mental, and spiritual needs of students should seek to employ caring techniques across all three domains. Providing or facilitating spiritual care may be emphasized in schools as the study revealed the role of religiosity in predicting QOL above and beyond COVID-19 related stress.

Supporting religious activities may benefit college students. Religious gatherings may build a sense of community and engagement, and times of individual prayer and corporate prayer may also improve QOL and decrease stress. This study further suggests that college leaders and faculty should support student engagement within their religious backgrounds. Faculty can offer a time of quiet contemplation or offer to pray with students. Leaders can create an open policy accepting healthy religious activities.

7. Limitations

Limitations of this study exist, though study methods and researchers attempted to control for limitations. The study participants were largely from the U.S.; therefore, generalizability to all university students is limited when considering the diverse effects that the COVID-19 pandemic had on various countries. Second, the instruments used were self-report measurements, causing a potential bias in participant reporting. Bias may also exist due to the sampling technique used (convenience sampling). Additionally, data were collected during the pandemic; therefore, comparison to pre-COVID-19 pandemic perspectives is limited. Most participants self-reported as Christians (77.8%) and as attending a faith-based school (65.9%), limiting generalizability to students of other faiths.

8. Research recommendations

Due to these limitations, we recommend further research in this topic area. Additional research will be required to ascertain the impact of religiosity on the long-term effects of the pandemic on college students’ on QOL and stress. In order to offer a more global assessment of the correlation of religiosity, further research should be conducted including participants from multiple countries, religions, faiths, and educational settings. Further research should take place to understand the relationship of religiosity and resilience on QOL and stress of university students during times of high stress, such as a global pandemic.

Qualitative research on the influence of religiosity on stress and QOL should also be considered. Gaining additional information on the college student’s perception of the correlation between stress, QOL, and religiosity would add value to the body of research. Considering that today’s younger college students experienced the COVID-19 pandemic while in high school, differences in religiosity, stress, and QOL may exist. Research should be completed to assess differences between these distinct populations.

9. Conclusion

This study revealed a majority of college students are dealing with some level of stress, while 22% of them are dealing with a higher level of stress (similar to severe post-traumatic stress disorder) due to the COVID-19 pandemic. In this study, we found significant associations between religiosity, QOL indicators, and COVID-19 related stress. It is likely that the overall COVID-19 related stress and QOL are buffered by religiosity. Based on the results, we can develop strategies to meet the needs of the students. Students need emotional, spiritual, and social support to get through this crisis. Interestingly, students with religiosity scores which impact their daily lives have a correlation with handling stress better, specifically COVID-19 stressors. Therefore, academic administrators may need to allocate more resources and services for spiritual growth, health interventions, and mental health programs to assist with these issues.

Data Sharing

The basic data can be shared upon request.

Correction

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The authors did not receive any funding for this study

Notes on contributors

Rachel A. Joseph

Rachel A. Joseph is an Associate Professor at Liberty University School of Nursing (LUSON), where she has taught across all program levels since 2019. She is a Specialty certified neonatal critical care nurse (CCRN), obtained PhD from Duquesne University and has taught pediatric nursing in clinical and classroom. She has served in the Ministry of Health in Oman and was a Fulbright scholar to Jordan in 2019. She has presented at several local, national, and international conferences and has published several articles. Her research interests include Quality of life, stress and coping, spiritual care, forgiveness, family caregivers, health literacy, and education.

Jichan J. Kim

Jichan J. Kim is an Associate Professor in the department of psychology at Liberty University and is an expert in forgiveness research.

Shanna W. Akers

Shanna W. Akers a former School of Nursing is Dean and Professor, where she taught across all program levels. Shanna completed her nursing licensure program at Louisiana Tech University, her bachelors from Virginia Commonwealth University, and her MSN and MBA. Her Doctor of Education (EdD) was awarded in 2015 with honors and her dissertation assessing the relationship between clinical and simulation experiences and knowledge and self-efficacy. She has been a member of Sigma Theta Tau International since 1999, is an AACN-Wharton Executive Leadership Fellow, serves on the Virginia Nurses Association board, and is active in a variety of nursing and education initiatives.

Tracey Turner

Tracey Turner is an Associate Professor at Liberty University’s School of Nursing (LUSON), where she has taught in the undergraduate and graduate programs since 2008. After completing BSN and MSN from the University of Virginia, Tracey completed her Doctor of Education (EdD) at Liberty University. Dr. Turner is a member of the Virginia Nurses Association, Sigma Theta Tua International, and the Association of Women’s Health, Obstetrics, and Neonatal Nurses. She is certified in Inpatient Obstetrics.

Elizabeth Whorley

Elizabeth Whorley is an Associate Professor of Nursing at Liberty University. She serves as the Chair of the Online Undergraduate and Graduate Nursing programs. She completed her Bachelor of Science in Nursing and Master of Science in Nursing from Liberty University. She holds a PhD in Nursing Education from Nova Southeastern University of Florida. She is passionate about nursing education and research and seeks to create an innovative learning environment that excellence in nursing.

Kelly Lumpkin

Kelly Lumpkin is an Associate Profession in the department of Athletics in the school of Health Sciences.

Jenna Rosa

Jenna Rosa and Catherine McElroy are nursing students in the School of Nursing.

Catherine McElroy

Jenna Rosa and Catherine McElroy are nursing students in the School of Nursing.