The Effect of Spiritual Well-Being on Psychological Resilience in Patients with Multiple Sclerosis
Year 2025,
Volume: 14 Issue: 3, 696 - 703, 31.10.2025
Tülay Yıldırım Üşenmez
,
Rukiye Demir Dikmen
Abstract
Objective: The present study purposed to explore the effect of spiritual well-being (sp) on psychological resilience in patients with Multiple Sclerosis (MS). Materials and Methods: The present cross-sectional study was conducted in the a State Hospital’s Neurology outpatient policlinics and an inpatient clinic between July and September 2024. Sixty-eight (68) patients with MS participated in the present study. Brief Resilience Scale (BRS) and Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale (FACIT-Sp) were utilized to gather data. Results: It was found that patients’ total mean scores was 21.07±8.92 for FACIT-Sp and 14.02±6.17 for BRS. There was a statistically positive and strong relationship between FACIT-Sp and BRS (r=0.910, p<0.01). Additionally, it was found that sp predicted psychological resilience by 82% Conclusion: In the study, it was stated that the sp and psychological resilience of the patients were low level. It can also be said that the level of sp of patients with MS may positively affect their psychological resilience.
Ethical Statement
Firstly, approval from the Ethics Committee (Approv Number: 2024/645588) and official permit from the a State Hospital. Patients were instructed on the study’s purpose and that their knowledge would be kept private and that they could draw back from the study at any time. Additionally, the present study was conducted taking into account the Principles of the Declaration of Helsinki and by getting written consent from the patients with an 'Informed Voluntary Consent Form'.
Thanks
The authors would like to thank anyone who contributed
to this study sincerely.
References
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Aktaş, A., Aştı, T. A., Bakanoğlu, E., & Çelebioğlu, M. (2010). Determination of the body image perception of a nursing college students. Florence Nightingale Nursing Journal, 18(2), 63-71.
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Aktürk, Ü., Erci, B., & Araz, M. (2017). Functional evaluation of treatment of chronic disease: validity and reliability of the Turkish version of the spiritual well-being scale. Palliative & Supportive Care, 15, 684. https://doi.org/10.1017/s1478951517000013
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Allahbakhshian, M., Jafarpour, M., & Parvizi, S. (2011b). Spiritual well-being of patients with multiple sclerosis. Iranian Journal of Nursing and Midwifery Research, 16(3), 202. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249799/
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Allahbakhshian, M., Jaffarpour, M., Parvizy, S., & Haghani, H. (2010a). A survey on relationship between spiritual wellbeing and quality of life in multiple sclerosis patients. Zahedan Journal of Research in Medical Sciences, 12(3). https://pubmed.ncbi.nlm.nih.gov/22224107/
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Battalio, S. L., Silverman, A. M., Ehde, D. M., Amtmann, D., Edwards, K. A., & Jensen, M. P. (2017). Resilience and function in adults with physical disabilities: an observational study. Archives of Physical Medicine and Rehabilitation, 98(6), 1158–1164. https://doi.org/10.1016/j.apmr.2016.11.012
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Black, R., & Dorstyn, D. (2015). A biopsychosocial model of resilience for multiple sclerosis. Journal of Health Psychology, 20(11), 1434-1444. https://doi:10.1177/1359105313512879
-
Doğan, T. (2015). Kısa Psikolojik Sağlamlık Ölçeği’nin Türkçe uyarlaması: Geçerlik ve güvenirlik çalışması. The Journal of Happiness & Well-Being, 3, 93–102.
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Esmaili, A. A., Bahari, F., & Farahani, M. M. (2014). The effectiveness of happiness training on resiliency in patients with multiple sclerosis (MS). Indian Journal of Health and Wellbeing, 5(2), 237. http://www.iahrw.com/index.php/home/journal_detail/19#list
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Fombuena, M., Galiana, L., Barreto, P., Olive, A., Pascual, A., & Rubio, A. S. (2016). Spirituality in patients with advanced illness: The role of symptom control, resilience and social network. Journal of Health Psychology, 21, 2765–2277. https://doi.org/10.1177/1359105315586213
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Gallo, A., & Bisecco, A. (2021). Psychological resilience explains functional variability across people with multiple sclerosis–Commentary. Multiple Sclerosis Journal, 27(4), 506-508. https://doi:10.1177/1352458520978213
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Ghabaee, D.N.Z., Bagheri-Nesami, M., & Malekzadeh Shafaroudi, M. (2016). Relationship between spiritual well-being and quality of life in multiple sclerosis patients. Journal of Nursing and Midwifery Sciences ,3(2), 25-31. https://doi:10.18869/acadpub.jnms.3.2.25
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Hadianfard, H., Ashjazadeh, N., Feridoni, S., & Farjam, E. (2015). The role of psychological resilience, severity of disease and treatment adherence in the prediction of health-related quality of life in patients with multiple sclerosis. Neurology Asia, 20(3), 263-268. https://www.neurology-asia.org/articles/neuroasia-2015-20(3)-263.pdf
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Iranmanesh, S., Tirgari, B., Tofighi, M., & Forouzi, M. A. (2014). Spiritual wellbeing and perceived uncertainty in patients with multiple sclerosis in south-east Iran. International Journal of Palliative Nursing, 20(10), 483-492. https://doi.org/10.12968/ijpn.2014.20.10.483
-
Khari, S., & Pazokian, M. (2024). Influence of religion and spirituality on the mental health of patients with multiple sclerosis. Journal of Spirituality in Mental Health, 26(2), 128–140. https://doi.org/10.1080/19349637.2023.2174920
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Liu, L., Fu, M., Wu, J., Wang, H., Zhao, J., Chen, P., Cao, J., Zhang, W., Lin, Q., & Li, L. (2024). Digital health literacy among undergraduate nursing students in China: associations with health lifestyles and psychological resilience. BMC Medical Education, 24(1), 1139. https://doi.org/10.1186/s12909-024-06075-w
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McNulty, K., Livneh, H., & Wilson, L. M. (2004). Perceived uncertainty, spiritual well-being, and psychosocial adaptation in ındividuals with multiple sclerosis. Rehabilitation Psychology, 49(2), 91–99. https://doi.10.1037/0090-5550.49.2.91
-
Mohammadizadeh, A., Askarizadeh, G., & Bagheri, M. (2017). The relationship between spiritual health and death anxiety in patients with multiple sclerosis. Journal of Religion and Health, 4(2), 20-28. http://jrh.mazums.ac.ir/article-1-335-en.html
-
Mohr, D.C., Dick, L.P., Russo, D., Pinn, J., Boudewyn, A.C., Likosky, W., & Goodwin, D.E. (1999). The psychosocial impact of multiple sclerosis: Exploring the patient’s perspective. Health Psychology, 18, 376–382. https://doi:10.1037//0278-6133.18.4.376
-
Nakazawa, K., Noda, T., Ichikura, K., Okamoto, T., Takahashi, Y., Yamamura, T., & Nakagome, K. (2018). Resilience and depression/anxiety symptoms in multiple sclerosis and neuromyelitis optica spectrum disorder. Multiple Sclerosis and Related Disorders, 25, 309-315. https://doi.org/10.1016/j.msard.2018.08.023
-
Nazari, F., & Shaygannejad, V. (2021). The relationship between spiritual well-being and perceived social support in patients with multiple sclerosis. Research Square, https://doi.org/10.21203/rs.3.rs-261880/v1
-
Niyazmand, Z. A., Abbasszadeh, A., Borhani, F., & Sefidkar, R. (2018). The relationship between spiritual health and hope in multiple sclerosis patients: A descriptive-correlational study. Electronic Journal of General Medicine, 15(5). https://doi.org/10.29333/ejgm/93464
-
Nsamenang, S. A., Hirsch, J. K., Topciu, R., Goodman, A. D., & Duberstein, P. R. (2016). The interrelations between spiritual well-being, pain interference and depressive symptoms in patients with multiple sclerosis. Journal of Behavioral Medicine, 39(2), 355-363. https://doi:10.1007/s10865-016-9712-3
of Life Among Patients With Multiple Sclerosis. Journal of Religion&Health, 56, 1826-1836. https://doi.10.1007/s10943-017-0411-3
-
Pagnini, F., Bosma, C. M., Phillips, D., & Langer, E. (2014). Symptom changes in multiple sclerosis following psychological interventions: a systematic review. BMC Neurology, 14(1), 1-9. https://doi:10.1186/s12883-014-0222-z
-
Paloutzian, R. F., & Ellison, C. W. (1982). Loneliness, spiritual well-being and the quality of life. Loneliness: A sourcebook of current theory. Research and Therapy, 224-227.
https://www.scirp.org/(S(i43dyn45teexjx455qlt3d2q))/reference/ReferencesPapers.aspx?ReferenceID=1300047
-
Ploughman, M., Downer, M. B., Pretty, R. W., Wallack, E. M., Amirkhanian, S., Kirkland, M. C., & Health, Lifestyle and Aging with MS Canadian Consortium (2020). The impact of resilience on healthy aging with multiple sclerosis. Quality of Life Research : an İnternational Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 29(10), 2769–2779. https://doi.org/10.1007/s11136-020-02521-6
-
Rainone, N., Chiodi, A., Lanzillo, R., Magri, V., Napolitano, A., Morra, V. B., ... & Freda, M. F. (2017). Affective disorders and health-related quality of life (HRQoL) in adolescents and young adults with multiple sclerosis (MS): the moderating role of resilience. Quality of Life Research, 26(3), 727-736. https://doi:10.1007/s11136-016-1466-4
-
Setareh, J., Monajemi, M. B., Abedini, M., Tasha, M., & Setareh, S. (2017). Comparing defense mechanisms, resilience and cognitive distortion of patients with multiple sclerosis and healthy individuals. Global Journal of Health Science, 9(10), 1-44. https://doi.org/10.5539/gjhs.v9n10p44
-
Shaygannejad, V., & Mohamadirizi, S. (2020). Spiritual health in women with multiple sclerosis and its association with self-esteem. Journal of Education and Health Promotion, 9 (64), 1-5. https://doi:10.4103/jehp.jehp_144_19
-
Shen, Z. M., Wang, Y. Y., Cai, Y. M., Li, A. Q., Zhang, Y. X., Chen, H. J., Jiang, Y. Y., & Tan, J. (2024). Thriving at work as a mediator of the relationship between psychological resilience and the work performance of clinical nurses. BMC Nursing, 23(1), 194. https://doi.org/10.1186/s12912-024-01705-6
-
Silverman, A. M., Verrall, A. M., Alschuler, K. N., Smith, A. E., & Ehde, D. M. (2017). Bouncing back again, and again: a qualitative study of resilience in people with multiple sclerosis. Disability and Rehabilitation, 39(1), 14-22. https://doi.org/10.3109/09638288.2016.1138556
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Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The brief resilience scale: assessing the ability to bounce back. International Journal of Behavioral Medicine, 15(3), 194–200. https://doi.org/10.1080/10705500802222972
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Smith, L., Webber, R., & DeFrain, J. (2013). Spiritual well-being and its relationship to resilience in young people: A mixed methods case study. SAGE Open, 3, 1–16.
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Terrill, A. L., Molton, I. R., Ehde, D. M., Amtmann, D., Bombardier, C. H., Smith, A. E., & Jensen, M. P. (2016). Resilience, age, and perceived symptoms in persons with long-term physical disabilities. Journal of Health Psychology, 21(5), 640-649. https://doi.org/10.1177/1359105314532973
-
Thomas, L. J., & Asselin, M. (2018). Promoting resilience among nursing students in clinical education. Nurse Education in Practice, 28, 231–234. https://doi.org/10.1016/j.nepr.2017.10.001
-
Turpin K.V. Ph.D. Thesis. University of Alberta; Edmonton, AB, Canada: 2020. Understanding resilience in persons with multiple sclerosis.
-
Vizehfar, F., & Jaberi, A. (2017). The relationship between religious beliefs and quality of life among patients with multiple sclerosis. Journal of Religion and Health, 56(5), 1826–1836. https://doi.org/10.1007/s10943-017-0411-3
-
Zarei, B., Vagharseyyedin, S. A., & Gorganie, E. (2015). Relationship between spiritual well-being and self-management among Iranian people with multiple sclerosis. Jundishapur Journal of Chronic Disease Care, 4(4), 18-24. https://doi.org/10.17795/jjcdc-30154
Multipl Skleroz Hastalarında Ruhsal Refahın Psikolojik Dayanıklılık Üzerindeki Etkisi
Year 2025,
Volume: 14 Issue: 3, 696 - 703, 31.10.2025
Tülay Yıldırım Üşenmez
,
Rukiye Demir Dikmen
Abstract
Amaç: Bu çalışma, Multiple skleroz hastalarında manevi iyi oluşun psikolojik sağlamlığa etkisini belirlemeyi amaçlamaktadır. Gereç ve Yöntem: Kesitsel türdeki bu çalışma Temmuz-Eylül 2024 tarihleri arasında bir devlet hastanesinin nöroloji poliklinikleri ve kliniğinde yürütüldü. Mevcut çalışmaya 68 Multiple Skleroz hastası katıldı. Verileri toplamak için Kısa Psikolojik Sağlamlık Ölçeği (KPSÖ) ve Manevi İyi Oluş Ölçeği (MİOÖ) kullanıldı. Bulgular: Hastaların MİOÖ toplam puan ortalaması 21.07±8.92, KPSÖ toplam puan ortalaması 14.02±6.17 olarak bulundu. Manevi iyi oluş ile psikolojik sağlamlık arasında pozitif yönlü güçlü bir ilişki vardır. Ayrıca, manevi iyi oluşun psikolojik sağlamlığı %82 oranında yordadığı da bulundu. Sonuç: Çalışmada, hastaların manevi iyi oluş ve psikolojik sağlamlık düzeyinin düşük olduğu belirlendi. MS hastalarının manevi iyi oluş düzeyinin psikolojik sağlamlığı olumlu olarak etkileyebileceği de söylenebilir.
References
-
Aktaş, A., Aştı, T. A., Bakanoğlu, E., & Çelebioğlu, M. (2010). Determination of the body image perception of a nursing college students. Florence Nightingale Nursing Journal, 18(2), 63-71.
-
Aktürk, Ü., Erci, B., & Araz, M. (2017). Functional evaluation of treatment of chronic disease: validity and reliability of the Turkish version of the spiritual well-being scale. Palliative & Supportive Care, 15, 684. https://doi.org/10.1017/s1478951517000013
-
Allahbakhshian, M., Jafarpour, M., & Parvizi, S. (2011b). Spiritual well-being of patients with multiple sclerosis. Iranian Journal of Nursing and Midwifery Research, 16(3), 202. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249799/
-
Allahbakhshian, M., Jaffarpour, M., Parvizy, S., & Haghani, H. (2010a). A survey on relationship between spiritual wellbeing and quality of life in multiple sclerosis patients. Zahedan Journal of Research in Medical Sciences, 12(3). https://pubmed.ncbi.nlm.nih.gov/22224107/
-
Battalio, S. L., Silverman, A. M., Ehde, D. M., Amtmann, D., Edwards, K. A., & Jensen, M. P. (2017). Resilience and function in adults with physical disabilities: an observational study. Archives of Physical Medicine and Rehabilitation, 98(6), 1158–1164. https://doi.org/10.1016/j.apmr.2016.11.012
-
Black, R., & Dorstyn, D. (2015). A biopsychosocial model of resilience for multiple sclerosis. Journal of Health Psychology, 20(11), 1434-1444. https://doi:10.1177/1359105313512879
-
Doğan, T. (2015). Kısa Psikolojik Sağlamlık Ölçeği’nin Türkçe uyarlaması: Geçerlik ve güvenirlik çalışması. The Journal of Happiness & Well-Being, 3, 93–102.
https://www.tayfundogan.net/wpcontent/uploads/2016/09/K%C4%B1saPsikolojikSaglamlikOlcegi.pdf
-
Esmaili, A. A., Bahari, F., & Farahani, M. M. (2014). The effectiveness of happiness training on resiliency in patients with multiple sclerosis (MS). Indian Journal of Health and Wellbeing, 5(2), 237. http://www.iahrw.com/index.php/home/journal_detail/19#list
-
Fombuena, M., Galiana, L., Barreto, P., Olive, A., Pascual, A., & Rubio, A. S. (2016). Spirituality in patients with advanced illness: The role of symptom control, resilience and social network. Journal of Health Psychology, 21, 2765–2277. https://doi.org/10.1177/1359105315586213
-
Gallo, A., & Bisecco, A. (2021). Psychological resilience explains functional variability across people with multiple sclerosis–Commentary. Multiple Sclerosis Journal, 27(4), 506-508. https://doi:10.1177/1352458520978213
-
Ghabaee, D.N.Z., Bagheri-Nesami, M., & Malekzadeh Shafaroudi, M. (2016). Relationship between spiritual well-being and quality of life in multiple sclerosis patients. Journal of Nursing and Midwifery Sciences ,3(2), 25-31. https://doi:10.18869/acadpub.jnms.3.2.25
-
Hadianfard, H., Ashjazadeh, N., Feridoni, S., & Farjam, E. (2015). The role of psychological resilience, severity of disease and treatment adherence in the prediction of health-related quality of life in patients with multiple sclerosis. Neurology Asia, 20(3), 263-268. https://www.neurology-asia.org/articles/neuroasia-2015-20(3)-263.pdf
-
Iranmanesh, S., Tirgari, B., Tofighi, M., & Forouzi, M. A. (2014). Spiritual wellbeing and perceived uncertainty in patients with multiple sclerosis in south-east Iran. International Journal of Palliative Nursing, 20(10), 483-492. https://doi.org/10.12968/ijpn.2014.20.10.483
-
Khari, S., & Pazokian, M. (2024). Influence of religion and spirituality on the mental health of patients with multiple sclerosis. Journal of Spirituality in Mental Health, 26(2), 128–140. https://doi.org/10.1080/19349637.2023.2174920
-
Liu, L., Fu, M., Wu, J., Wang, H., Zhao, J., Chen, P., Cao, J., Zhang, W., Lin, Q., & Li, L. (2024). Digital health literacy among undergraduate nursing students in China: associations with health lifestyles and psychological resilience. BMC Medical Education, 24(1), 1139. https://doi.org/10.1186/s12909-024-06075-w
-
McNulty, K., Livneh, H., & Wilson, L. M. (2004). Perceived uncertainty, spiritual well-being, and psychosocial adaptation in ındividuals with multiple sclerosis. Rehabilitation Psychology, 49(2), 91–99. https://doi.10.1037/0090-5550.49.2.91
-
Mohammadizadeh, A., Askarizadeh, G., & Bagheri, M. (2017). The relationship between spiritual health and death anxiety in patients with multiple sclerosis. Journal of Religion and Health, 4(2), 20-28. http://jrh.mazums.ac.ir/article-1-335-en.html
-
Mohr, D.C., Dick, L.P., Russo, D., Pinn, J., Boudewyn, A.C., Likosky, W., & Goodwin, D.E. (1999). The psychosocial impact of multiple sclerosis: Exploring the patient’s perspective. Health Psychology, 18, 376–382. https://doi:10.1037//0278-6133.18.4.376
-
Nakazawa, K., Noda, T., Ichikura, K., Okamoto, T., Takahashi, Y., Yamamura, T., & Nakagome, K. (2018). Resilience and depression/anxiety symptoms in multiple sclerosis and neuromyelitis optica spectrum disorder. Multiple Sclerosis and Related Disorders, 25, 309-315. https://doi.org/10.1016/j.msard.2018.08.023
-
Nazari, F., & Shaygannejad, V. (2021). The relationship between spiritual well-being and perceived social support in patients with multiple sclerosis. Research Square, https://doi.org/10.21203/rs.3.rs-261880/v1
-
Niyazmand, Z. A., Abbasszadeh, A., Borhani, F., & Sefidkar, R. (2018). The relationship between spiritual health and hope in multiple sclerosis patients: A descriptive-correlational study. Electronic Journal of General Medicine, 15(5). https://doi.org/10.29333/ejgm/93464
-
Nsamenang, S. A., Hirsch, J. K., Topciu, R., Goodman, A. D., & Duberstein, P. R. (2016). The interrelations between spiritual well-being, pain interference and depressive symptoms in patients with multiple sclerosis. Journal of Behavioral Medicine, 39(2), 355-363. https://doi:10.1007/s10865-016-9712-3
of Life Among Patients With Multiple Sclerosis. Journal of Religion&Health, 56, 1826-1836. https://doi.10.1007/s10943-017-0411-3
-
Pagnini, F., Bosma, C. M., Phillips, D., & Langer, E. (2014). Symptom changes in multiple sclerosis following psychological interventions: a systematic review. BMC Neurology, 14(1), 1-9. https://doi:10.1186/s12883-014-0222-z
-
Paloutzian, R. F., & Ellison, C. W. (1982). Loneliness, spiritual well-being and the quality of life. Loneliness: A sourcebook of current theory. Research and Therapy, 224-227.
https://www.scirp.org/(S(i43dyn45teexjx455qlt3d2q))/reference/ReferencesPapers.aspx?ReferenceID=1300047
-
Ploughman, M., Downer, M. B., Pretty, R. W., Wallack, E. M., Amirkhanian, S., Kirkland, M. C., & Health, Lifestyle and Aging with MS Canadian Consortium (2020). The impact of resilience on healthy aging with multiple sclerosis. Quality of Life Research : an İnternational Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 29(10), 2769–2779. https://doi.org/10.1007/s11136-020-02521-6
-
Rainone, N., Chiodi, A., Lanzillo, R., Magri, V., Napolitano, A., Morra, V. B., ... & Freda, M. F. (2017). Affective disorders and health-related quality of life (HRQoL) in adolescents and young adults with multiple sclerosis (MS): the moderating role of resilience. Quality of Life Research, 26(3), 727-736. https://doi:10.1007/s11136-016-1466-4
-
Setareh, J., Monajemi, M. B., Abedini, M., Tasha, M., & Setareh, S. (2017). Comparing defense mechanisms, resilience and cognitive distortion of patients with multiple sclerosis and healthy individuals. Global Journal of Health Science, 9(10), 1-44. https://doi.org/10.5539/gjhs.v9n10p44
-
Shaygannejad, V., & Mohamadirizi, S. (2020). Spiritual health in women with multiple sclerosis and its association with self-esteem. Journal of Education and Health Promotion, 9 (64), 1-5. https://doi:10.4103/jehp.jehp_144_19
-
Shen, Z. M., Wang, Y. Y., Cai, Y. M., Li, A. Q., Zhang, Y. X., Chen, H. J., Jiang, Y. Y., & Tan, J. (2024). Thriving at work as a mediator of the relationship between psychological resilience and the work performance of clinical nurses. BMC Nursing, 23(1), 194. https://doi.org/10.1186/s12912-024-01705-6
-
Silverman, A. M., Verrall, A. M., Alschuler, K. N., Smith, A. E., & Ehde, D. M. (2017). Bouncing back again, and again: a qualitative study of resilience in people with multiple sclerosis. Disability and Rehabilitation, 39(1), 14-22. https://doi.org/10.3109/09638288.2016.1138556
-
Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The brief resilience scale: assessing the ability to bounce back. International Journal of Behavioral Medicine, 15(3), 194–200. https://doi.org/10.1080/10705500802222972
-
Smith, L., Webber, R., & DeFrain, J. (2013). Spiritual well-being and its relationship to resilience in young people: A mixed methods case study. SAGE Open, 3, 1–16.
-
Terrill, A. L., Molton, I. R., Ehde, D. M., Amtmann, D., Bombardier, C. H., Smith, A. E., & Jensen, M. P. (2016). Resilience, age, and perceived symptoms in persons with long-term physical disabilities. Journal of Health Psychology, 21(5), 640-649. https://doi.org/10.1177/1359105314532973
-
Thomas, L. J., & Asselin, M. (2018). Promoting resilience among nursing students in clinical education. Nurse Education in Practice, 28, 231–234. https://doi.org/10.1016/j.nepr.2017.10.001
-
Turpin K.V. Ph.D. Thesis. University of Alberta; Edmonton, AB, Canada: 2020. Understanding resilience in persons with multiple sclerosis.
-
Vizehfar, F., & Jaberi, A. (2017). The relationship between religious beliefs and quality of life among patients with multiple sclerosis. Journal of Religion and Health, 56(5), 1826–1836. https://doi.org/10.1007/s10943-017-0411-3
-
Zarei, B., Vagharseyyedin, S. A., & Gorganie, E. (2015). Relationship between spiritual well-being and self-management among Iranian people with multiple sclerosis. Jundishapur Journal of Chronic Disease Care, 4(4), 18-24. https://doi.org/10.17795/jjcdc-30154