Domains of spirituality and their associations with positive mental health: A study of adolescents in Canada, England and Scotland

The assessment in populations of young people remains an immense challenge. Efforts to perform such assessments typically involve use of unidimensional scales incorporating items related to four domains (connections to “self”, “others”, “nature”, and the “transcendent”). For adolescents, it remains unclear whether these domains equally influence mental health, or if one domain is particularly important. We analyzed reports from adolescents who participated in the 2014 Health Behaviour in School-aged Children (HBSC) study conducted in Canada, England and Scotland. Reports of positive mental health were modelled as a function of ordinal scores describing each spiritual health domain, controlling for age, the other domains, and potential confounders. We identified strong and consistent associations between positive mental health and higher scores for each of the four spiritual health domains. While associations exist between each of the four domains of spiritual health and positive mental health, it appears that associations with connections to “others”, “nature”, and the “transcendent” are sometimes mediated by connections to “self”. Implications for assessment, models and related interventions and health promotion strategies, based on the idea that inner connections may be central to the protective effects of spiritual health, are considered.