PREDICTING WELL-BEING OF BULGARIAN UNIVERSITY STUDENTS

IN HEALTH SCIENCES: THE ROLE OF RELIGIOUS AND SECULAR

MEANING-MAKING COPING

Kremena Mineva 1

PSIQUE • EISSN 21834806 • VOLUME XX • ISSUE FASCÍCULO 2

1ST JULY JULHO  31ST DECEMBER DEZEMBRO 2024 • PP. 5771

DOI: https://doi.org/10.26619/2183-4806.XX.2.4

Submitted on 03/03/2024 Submetido a 03/03/2024

Accepted on 30/06/2024 Aceite a 30/06/2024

Abstract

Students in the health sciences are exposed to intense daily stressors that negatively affect

their well-being. Meaning-making coping is widely recognized as a protective factor for well-be-

ing during acute stress, but understanding of its effects in the face of everyday difficulties is

more limited. This study aimed to examine the effects of religious and secular (non-religious)

meaning-making coping on the well-being domains of health science students and the role of

perceived stress as a mediator in these relationships. A total of 227 Bulgarian university stu-

dents participated in the study (M age = 30.27; SD = 10.91). Analyses revealed that secular mean-

ing-making coping directly positively predicted subjective, psychological and social well-be-

ing, with medium to large effect sizes. Perceived stress emerged as a partial mediator of these

relationships. Religious coping did not predict well-being either directly or indirectly via per-

ceived stress. The study highlights the positive influence of a non-religious way of making sense

of everyday stressors on students‘ well-being, and identifies perceived stress as a mechanism

through which this influence is partially realized. The findings suggest that the inclusion of sec-

ular meaning-making may be appropriate in programs designed to promote the well-being of

these students.

Keywords: coping, meaning, religion, stress, well-being

1 ORCID ID: 0000-0002-6470-8708

Faculty of Medicine, Trakia University, Stara Zagora, Bulgaria

Armejska Street 11, 6000, Stara Zagora, Bulgaria

kremena.mineva@trakia-uni.bg

The author has no funding to report.

The author declares that no competing interests exist.

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Kremena Mineva

Introduction

Health sciences students are exposed to higher levels of stress than students in other disci-

plines due to academic workload, high competitiveness, being in a hospital environment, and

increasing responsibilities during training (e.g., Khazir et al., 2019). Stress leads to difficulties in

interacting with patients, poor academic performance, and a high prevalence of stress-related

disorders among these students worldwide (e.g., Quek et al., 2019). According to a meta-analysis

of longitudinal studies, stress was one of the factors with a strong negative impact on the dynam-

ics of student well-being (du Toit et al., 2022). Well-being is considered an indicator of positive

mental health, along with the absence of psychopathological symptoms (Keyes & Martin, 2017).

Well-being is associated with optimal psychosocial functioning, and has been operationalized

as: subjective, referring to the experience of life satisfaction and happiness; psychological, refer-

ring to a sense of optimal fulfillment of personal potential, self-acceptance, self-efficacy, and

autonomy; and social, referring to the experience of positive relationships and a sense of belong-

ing to a community (Keyes & Martin, 2017). High levels of student well-being have been posi-

tively associated with academic performance and college retention (Kryza-Lacombe et al., 2019),

and given the negative impact of stress on well-being, it is important that students use coping

styles that promote well-being.

In addition to problem-focused and emotion-focused coping, the extended transactional

model of stress emphasizes the role of meaning-making as coping in the context of extreme

stress (Park & Folkman, 1997). According to the meaning-making model, meaning operates at two

levels: global - based on the individual’s core beliefs, goal hierarchy, and values; and situational -

related to the ascribed meaning of a specific context or situation. Stressful events disrupt global

meaning, which causes distress, but meaning-making improves the correspondence between

the two levels of meaning and reduces distress (Park & Kennedy, 2017). Meaning-making uses

reappraisal strategies based on different sources of meaning and, depending on these sources,

can be religious and secular (non-religious) in nature. Religious meaning-making is based on

religion as a primary source of global meaning and creates situational meaning according to a

religious meaning system (Park, 2011). Specifically, stressful events can be interpreted as having

potentially beneficial implications for the individual’s relationship with God and the religious

community, i.e., positive religious coping (PRC), or the stressor can be seen as God’s punishment

for the person’s sins, lack of commitment, and unsatisfactory relationship with God and the reli-

gious community, i.e., negative religious coping (NRC) (Pargament, 1997). In secular (non-reli-

gious) meaning-making coping (SMMC), events are viewed according to sources of meaning of an

existential nature, such as the person himself, nature, or other people (Lloyd, 2018). Religious and

non-religious forms of meaning-making are closely related and interact with each other, but have

been shown to have different effects on student well-being (Ahmadi et al., 2022).

According to a systematic review, SMMC serves as a mechanism by which individuals main-

tain, restore, or even improve their mental health during a negative event (Métais et al., 2022).

Focusing on the potentially beneficial effects of distress on personal growth, social relationships,

or knowledge development reduces the negative mental health consequences of multiple intense

stressors. For example, a meta-analysis of cross-sectional studies found that the SMMS was neg-

atively associated with psychological distress during pandemic stress (Eisenbeck et al., 2022;

Cheng et al., 2024) and was much more predictive of distress than the specificity of stressors

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Predicting Well-being of Bulgarian University Students in Health Sciences:

The Role of Religious and Secular Meaning-Making Coping

and demographic characteristics combined (Milman et al., 2020; Negri et al., 2023). Use of the

SMMS has predicted higher positive affect and lower negative affect as an aspect of subjective

well-being in longitudinal studies of people who have experienced a traumatic event (Fitzke et

al., 2021; Paquin et al., 2021). Among college students, this coping has also directly and prospec-

tively predicted lower negative affect and more pronounced positive affect, in addition to higher

life satisfaction, during major life stressors (Wang et al., 2019; Lachnit et al., 2020; Yang et al.,

2021; Arslan, & Yıldırım, 2021).

Under conditions of highly intense and poorly controlled stress, the propensity to use SMMC

increases, including among college students (e.g., Yang et al., 2021), and SMMC has been shown to

be the strongest positive predictor of psychological well-being compared to problem-focused and

emotion-focused coping in a large-scale cross-cultural and multinational study (Eisenbeck et al.,

2022). However, there is evidence in the literature that meaning-making coping has been used in

addition to highly stressful events in situations that do not significantly disrupt global meaning

(George & Park, 2022). An experimental study inducing acute stress also found no differences in

the use of meaning-making coping, despite significant differences in levels of perceived stress

and valence of experienced affect between experimental and control groups (Petagna, 2021). This

coping style was shown to be one of the most commonly used by medical students to cope with

daily stress during training, and was applied to both moderate and high levels of stress (Labrague

et al., 2017). Another study in a large group of medical students found that SMMC reduced the

negative impact of study- and practice-related stress on subjective well-being (Leipold et al.,

2019) and facilitated adaptation to daily difficulties, even when they were of low intensity (Lau

& Tov, 2023). These findings suggest a broader link between such coping and well-being, not only

for traumatic stress, but also for everyday stress.

In contrast to the overwhelmingly positive associations of SMMC with well-being in the sci-

entific literature, religious meaning-making has shown inconsistent associations. For example, a

systematic review and meta-analysis of cross-sectional studies conducted in different countries,

mainly with student populations, found a weak, inconsistent negative relationship between NRC

and subjective well-being, and a weak but consistent positive relationship between PRC and sub-

jective well-being under intense and prolonged stress (Pankowski & Wytrychiewicz-Pankowska,

2023). Similar relationships have been found in other cross-sectional studies including medical

students (Francis et al., 2019; Counted et al., 2022; Skalski-Bednarz et al., 2022). A meta-analysis

of 42 studies with 25438 participants from 24 countries also found negative associations of NRC

with subjective well-being (Cheng et al., 2024). According to a longitudinal study, these associa-

tions were found not only for subjective but also for psychological well-being, with NRC having

a negative predictive effect, while the effect of PRC was positive, and these effects persisted

over time (Park et al., 2018). However, other studies present inconsistent or even contradictory

findings, such as that NRC, but not PRC, significantly negatively predicted psychological well-be-

ing (Pagán-Torres et al., 2021; Moussa et al., 2023), that PRC, but not NRC, positively predicted it

(Fatima et al., 2022), or that both NRC and PRC negatively predicted psychological well-being

among college students during acculturative stress (Somos, 2020). According to other authors,

there were no significant relationships between PRC and domains of well-being during stressful

events in either longitudinal or cross-sectional studies (Garssen et al., 2021; Surzykiewicz et al.,

2022), suggesting that the influence of religious meaning-making coping on well-being may man-

ifest indirectly through stress appraisals. For example, some authors found that under extreme

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stress, NRC correlated positively with perceived stress, leading to a more threatening perception

of stress (DeRossett et al., 2021), and PRC correlated negatively with perceived stress, reducing

its subjective severity (Mahamid & Bdier, 2021), and furthermore, through perceived stress, PRC

increased subjective well-being in emerging adults (Krok et al., 2023).

In summary, the literature highlights the positive impact of meaning-making in dealing with

difficult life circumstances, loss, traumatic events, or serious threats to health. Research consist-

ently highlights the positive association of SMMC with subjective well-being and the negative

association of NRC with subjective and psychological well-being. However, the relationships of

PRC with domains of well-being and those of SMMC with psychological and social well-being

are underrepresented or inconsistent. In addition, research has predominantly demonstrated the

effects of SMMC on well-being under conditions of high intensity and traumatic stress, but its

effects on well-being under everyday stress have been less studied. Furthermore, despite the

established associations of religious coping with appraisals of significant adversity, the role of

perceived stress as a mechanism by which both types of meandering coping influence well-be-

ing under everyday stress remains unclear. Health professions students are not only exposed to

higher levels of daily stress than their counterparts in other disciplines, but also to more intense

work stress, with increased manifestations of burnout (Caneca Murcho & Palma Pacheco, 2020).

This highlights the need to identify the factors and mechanisms that support optimal function-

ing of future health professionals, as measured by domains of well-being. The results could help

develop interventions for this type of student to prevent stress-related disorders and promote

their positive mental health, not only during their studies but also in their future work. There-

fore, the first aim of this study was to examine the effects of religious coping and SMMC on

health science students’ domains of well-being, and the second was to examine the mediating

role of perceived stress in the relationship between both types of meaning-making coping and

well-being.

It was hypothesized that:

H1: SMMC positively predicts subjective, psychological and social well-being.

H2: PRC positively predicts subjective, psychological and social well-being, and NRC nega-

tively predicts these domains.

H3: Perceived stress mediates the relationships of PRC, NRC, and SMMC with the domains of

well-being.

Methods

Participants

The study was carried out with 227 Bulgarian university students aged between 18 and

56 years (M= 30.27; SD= 10.91). The respondents were distributed by gender: male - 38 (16.7%),

female - 189 (83.3%); by specialty: medicine - 55 (24.2%), nursing - 97 (42.8%), midwifery - 33

(14.5%), medical assistant - 42 (18.5%); by religious affiliation: Christian - 155 (68.3%), Muslim - 60

(26.4%), other - 4 (1.8%), atheist - 8 (3.5%); by self-assessed religiousness: strongly religious - 25

(11%), moderately religious - 123 (54.2%), weakly religious - 62 (28.2%), not religious - 15 (6.6%).

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Predicting Well-being of Bulgarian University Students in Health Sciences:

The Role of Religious and Secular Meaning-Making Coping

Instruments

Data about age, gender, major studied, self-reported religiosity, and self-reported religious

affiliation were included in the survey.

Perceived Stress Scale (PSS; Cohen et al., 1983). The scale assessed the extent to which life situ-

ations are perceived as threatening, unpredictable, uncontrollable without specify the stressors.

It contains 14 items, each one being evaluated by respondents about frequency of occurrence in

the last month on a scale from 1 = “Never” to 5 = “Very often”. Higher results indicated higher

perceived stress level. Internal consistency of the scale in the study was Cronbach’s α = .65.

The Brief Multidimensional Measure of Religiousness and Spirituality (BMMRS; Fetzer, 2003).

The Religious Coping subscale was used to meet the objectives of the study. The term “God” was

replaced with “Higher Power” to make the statements appropriate for all religions. Respondents

were asked to indicate their agreement with the statements on a four-point response scale rang-

ing from 1 (very) to 4 (not at all). Four items measured PRC as being related to a person‘s tendency

to rely on a Higher Power in coping with difficulties (e.g., „I rely on a Higher Power for support

and guidance.“). The Cronbach‘s α reliability of PRC for the study was 0.76. Three items measured

NRC as a tendency to perceive difficulties as punishment or abandonment by a Higher Power

and to not rely on support in resolving them (e.g., „I wonder if a Higher Power has abandoned

me.“). The Cronbach‘s α reliability of NRC for the study was 0.56.

Meaning-Centered Coping Scale (MCCS; Eisenbeck et al., 2022). Scale measured coping focused

on creating personal meaning from stressful situations. It consisted of 9 items that were focused

on appreciation of one’s life in general (e.g., “I am grateful for my life as it is.”), on the tendency to

positively reframe difficulties (e.g., “I will come out of this situation stronger than I was before.”),

to maintain hope and courage, to engage in meaningful and pro-social activities also (e.g., “I am

helping others through this time.”). Statements were rated on a 7-point Likert scale from 1 (do not

agree at all) to 7 (strongly agree). The Cronbach’s α reliability for the study was 0.86.

Mental Health Continuum Short Form (MHC-SF; Keyes et al., 2008). Scale consisted of fourteen

items that assessed three domains of well-being. The three-items subjective well-being subscale

(SbWB) measured overall affect and general satisfaction with life. Social well-being subscale

(ScWB) consisted of five items that represent social contribution, social integration, social actu-

alization, social acceptance, and social coherence. Psychological well-being (PsWB) consisted of

six items that represent self-acceptance, environmental mastery, positive relations with others,

personal growth, autonomy and purpose in life. Participants were required to respond to items

on a 6-point Likert-type scale based on the experiences they had had over the last month (never,

once or twice, about once a week, 2 or 3 times a week, almost every day, or every day). In our

study internal consistencies were about SbWB - 0.82, ScWB- 0.73, PsWB- 0.81.

Procedure

The research was conducted in accordance with the ethical standards of the institutional

research committee and with the Declaration of Helsinki from 1965 and its later amendments

(World Medical Association, 2013). Prior to participating in the study, students were informed of

the purpose of the study and that participation was voluntary and anonymous. All participants

provided written informed consent. The study was conducted online via a Google form sent via

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email, and the form took approximately 15 minutes to complete. Participants received no reward

or credit and could withdraw from the study at any time without consequence.

Data analysis

Preliminary analyses were conducted to examine observed scale characteristics, assumption

of normality, and correlation estimates between the study variables. Normality was investigated

using Kolmogorov-Smirnov test. Pearson product-moment correlation analysis was conducted to

explore the associations between the variables of the study. Further, stepwise regression analy-

ses were carried out. Durbin Watson (DW) test was used to check multicollinearity in the regres-

sion models. A meditational analyses were conducted using the PROCESS macro (Model 4 for

SPSS version 4.2 (Hayes, 2018) while controlling age. The bootstrap method with 10 000 resam-

ples to estimate the 95% confidence interval (CI) was investigated for indirect effect. The data

were analyzed using the SPSS IBM software (Version 26).

Results

The assumption of normality of the distribution of results was accepted (p > .05). Correlation

analysis found that perceived stress correlated weakly to moderately negatively with domains

of well-being, weakly negatively correlated with SMMS, and no significant correlations were

found between perceived stress and RC. There was a weak positive correlation between PRC and

well-being domains, and a moderate positive correlation between SMMC with well-being (see

Table 1). Insert Table 1 here

Stepwise regression analyses were conducted with SMMC, PRC, and NRC as independent

variables (IV) and domains of well-being as dependent variables (DV). Results indicated that

SMMC positively predicted subjective well-being (β = .49, p < .001) with a large effect size. The

model was significant F (1, 223) = 70.561, p < .001 and explained 24% of the variance in DV, DW=

2.07. In addition, SMMC positively predicted social well-being (β = .36, p < .001) with a moderate

effect size. The model was significant, F (2, 224) = 32.527, p < .001, and explained 12.7% of the

variance in DV, DW = 2.16. In addition, SMMC positively predicted psychological well-being (β =

.55, p < .001) with a large effect size. The model was significant F (2, 224) = 99.0011, p < .001 and

explained 30.7% of the variance in DV, DW = 1.99.

To test Hypothesis 3, mediation analyses were conducted and the direct and indirect effects

were estimated. The direct effect referred to the pathway from IV to DV while controlling for

the mediator. The indirect effect described the pathway from IV to DV through the mediator.

The bootstrapping technique was used, and a significant effect was considered if the 95% CI did

not include zero. Age was entered as a covariate so that the mediation effects obtained were not

confounded by age.

Results showed that SMMC predicted subjective well-being both directly (α = .14, p < .001)

and indirectly (β = .07, Boot CI (.0393-.0921) (see Figure 1).

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Predicting Well-being of Bulgarian University Students in Health Sciences:

The Role of Religious and Secular Meaning-Making Coping

FIGURE1

Mediating effect of the perceived stress on the relationship between secular meaning-making coping and

subjective well-being

Note: [a] = is the effect of the IV on the mediator; [b] = is the effect of the mediator on the DV; [c] = total direct effect of IV on the DV without includ-

ing the mediator variable. [c’] = indirect effect of IV on DV considering the effect of the mediator variable. *p < .05; **p < .01; ***p < .001

Analyses also showed that SMMC directly predicted psychological well-being (β = .33, p <

.001), and the indirect effect through perceived stress was significant (β = .09, Boot CI (.0488-

.1363) (see Figure 2).

FIGURE2

Mediating effect of the perceived stress on the relationship between secular meaning-making coping and

psychological well-being

Note: [a] = is the effect of the IV on the mediator; [b] = is the effect of the mediator on the DV; [c] = total direct effect of IV on the DV without includ-

ing the mediator variable. [c’] = indirect effect of IV on DV considering the effect of the mediator variable. *p < .05; **p < .01; ***p < .001

There was a significant direct effect of SMMC on social well-being (β = .19, p < .001) as well

as a significant indirect effect on well-being via perceived stress (β = .06, Boot CI (.0250-.0938)

(see Figure 3).

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FIGURE3

Mediating effect of the perceived stress on the relationship between secular meaning-making coping and

social well-being

Note: [a] = is the effect of the IV on the mediator; [b] = is the effect of the mediator on the DV; [c] = total direct effect of IV on the DV without includ-

ing the mediator variable. [c’] = indirect effect of IV on DV considering the effect of the mediator variable. *p < .05; **p < .01; ***p < .001

From the demonstrated significant direct and indirect effects of SMMC on well-being

domains, it is concluded that perceived stress is a partial mediator in these relationships. No

significant direct and indirect effects of NRC and PRC on well-being domains were found, indi-

cating a lack of mediating effect of perceived stress in these relationships.

Discussion

The study showed that SMMS positively predicted domains of well-being with medium to

large effect sizes, consistent with previous findings, albeit in the context of intense adversity

(Yang et al., 2021; Eisenbeck et al., 2022). This suggests a role for everyday meaning-making in

promoting optimal psychological functioning, regardless of stress characteristics, and proposes

it as a general positive contributor to overall well-being. The study showed that SMMS led to

higher levels of well-being both directly and indirectly by reducing subjective appraisals of the

severity of stressors, supporting Hypothesis 1 and partially supporting Hypothesis 3. Students’

tendency to reappraise stressors more frequently based on personal meaning-making predicted

higher levels of well-being across all domains, in part due to more positive perceptions of stress.

It has been suggested that the predominant stressors for students are academic workloads,

which when perceived in terms of their benefits for future development and in line with global

meaning as goals and purpose in life, leads to their perception of them as a desirable challenge,

thus reducing the negative impact of stressors on well-being. This way of making sense of dif-

ficulties leads to greater life satisfaction, positive emotionality, positive social relationships, a

positive view of one’s own personality, a sense of autonomy, and self-efficacy not only in relation

to stressors but beyond. Other authors have identified the role of the SMQM as a mediator of

the relationship between personal resources for coping with stress and better student academic

performance, as well as a predictor of higher achievement through increased satisfaction with

learning (Ortega-Maldonado & Salanova, 2018). These findings suggest that the SMMS facilitates

student well-being through its functions of promoting positive appraisals of stress, as well as

other contributing functions.

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Predicting Well-being of Bulgarian University Students in Health Sciences:

The Role of Religious and Secular Meaning-Making Coping

The study found no direct effect of NRC and PRC on well-being, which does not support

Hypothesis 2. The results are consistent with previous research, albeit under conditions of

intense stress (Surzykiewicz et al., 2022), partially supporting others (Francis et al, 2019, Fattima

et al., 2022; Cheng et al., 2024) or not confirming them (Park et al., 2018; Pagán-Torres et al., 2021;

Pankowski & Wytrychiewicz-Pankowska, 2023; Moussa et al., 2023). The variability in the effects

of religious meaning-making on well-being when reappraising the meaning of stressors of differ-

ent intensity and duration suggests that its effects on psychological functioning under stress tend

to be highly context-dependent. The study showed that perceived stress was not significantly

correlated with either positive or negative religious coping, nor did it mediate their relationships

with well-being, thus Hypothesis 3 was not supported. The results suggest that appealing to a

higher power in the face of daily difficulties, whether in the form of support or by interpreting

them as punishment, does not appear to be related to subjective ratings of stress severity and

well-being among health science students. This trend differs from the positive relationships of

PRC with well-being and its negative relationships with perceived stress under significant hard-

ship outlined in previous research (Mahamid & Bdier, 2021; Fatima et al., 2022). The results sug-

gest that the tendency to make sense of everyday stress through religion, as opposed to its use for

traumatic stress, does not affect students’ well-being and how they perceive hardship. This may

be due to the more passive and avoidant nature of religious coping, which may be inappropriate

in situations of presumably more controllable stress in students’ daily lives, and which appeals

to more active and person-centered ways of making meaning, such as secular ones. Another

explanation for these findings relates to academic environments that foster a growth mindset

in students (Sisk et al., 2018) and encourage proactive rather than avoidant coping to reduce the

negative impact of stress on well-being (Burnette et al., 2020). Another presumed reason may be

rooted in the peculiarities of Bulgarian culture, which according to the Inglehart-Welzel cultural

map is classified as secular rather than religious (Wvs, 2023). Since religion is not very important

for the Bulgarian society, religious meaning-making did not have a significant impact on well-be-

ing and stress in the studied sample. According to other authors, in contemporary predominantly

secular societies, it is possible that religion is not used at all in making sense of stressful events

(Ahmadi & Ahmadi, 2017), and consequently, coping strategies that appeal to existential mean-

ing rather than religious meaning are more likely to be used.

Conclusions

The study shows that secular, but not religious meaning-making determines the well-being

of health science students. Subjective perceptions of stress serve as a mechanism through which

the effects are partially realized. Students’ tendency to reframe the meaning of daily adver-

sity through meanings focused on personal growth, values, and goals leads to better personal,

emotional, and social functioning due to a more positive perception of stress, but also beyond

this relationship. The tendency to reframe the meaning of everyday difficulties through their

religious significance appears to be irrelevant to the perception of stress and the experience of

well-being.

The study contributes to the understanding of meaning-making by highlighting its key role

in the processes of assessing ongoing stress and maintaining optimal psychological functioning.

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By differentiating the effects of the two types of meaning-making, the study also highlights the

positive effect of existential meaning-making on the well-being of health science students. By

confirming the effects on well-being already established in the literature under conditions of

intense and traumatic stress, it suggests its universal utility as a protective personal resource.

The findings suggests that enhancing the tendency to make sense of stressors through their exis-

tential and personal benefits may be appropriate for inclusion in stress management programs,

as well as those aimed at promoting the well-being of health science students.

Limitations and directions for future research

Several limitations of the present study should be noted, such as the small sample size, the

uneven distribution of respondents by gender, and the relevance of the findings only to the cul-

tural context in which they were obtained. To the extent that culture determines people’s pre-

disposition to prescribe primarily existential or religious meaning (Ahmadi & Ahmadi, 2017),

the impact of secular or religious meaning-making on well-being may be different for students

in other cultures. Furthermore, meaning-making is thought to be a multidimensional construct

with secular, religious, and spiritual components (Ahmadi & Ahmadi, 2022). Religiosity and

spirituality are seen as independent, yet interrelated constructs with different implications for

well-being. Religiosity is viewed as culturally grounded, institutionalized, and primarily focused

on specific belief systems and rituals, whereas spirituality refers to the experience of connect-

edness to transcendent realities such as a higher power, the universe, humanity, and the world

(Yaden et al., 2022). To the extent that these transcendent experiences can be enacted within or

outside a religious context, spirituality encompasses both religious and nonreligious characteris-

tics. However, measures of spiritual meaning-making do not always take these two aspects into

account, assuming that religious and spiritual coping are identical (Hill et al., 2000). In addition,

secular meaning-making has little to do with the religious meaning system, but may overlap with

the search for a connection to a sacred source without any connection to God or a traditional reli-

gious context (Ahmadi & Ahmadi, 2022). In support of this, and consistent with the tendency for

younger age cohorts to self-identify as spiritual but not religious, other authors have found that

spiritual meaning-making is not independent of secular meaning-making among younger and

more educated individuals (Cetrez et al., 2020). Therefore, it would be useful for future research

to focus on distinguishing secular, religious, and spiritual meaning-making as independent var-

iables, both in terms of measurement and their relationships with well-being and perceived

stress. Furthermore, examining these effects across gender, religious salience of culture, and age

cohorts may contribute to a more comprehensive understanding of the relationships of interest.

References

Ahmadi, N., & Ahmadi, F. (2017). The Use of Religious Coping Methods in a Secular Society: A Sur-

vey Study Among Cancer Patients in Sweden. Illness, Crisis & Loss, 25(3), 171–199. https://doi.

org/10.1177/1054137315614513

Ahmadi, F., & Ahmadi, N. (2022). Sanctification in Coping From a Cultural Perspective. Illness, Crisis &

Loss, 30(3), 465-488. https://doi.org/10.1177/1054137320982203

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Predicting Well-being of Bulgarian University Students in Health Sciences:

The Role of Religious and Secular Meaning-Making Coping

Ahmadi, F., Cetrez, Ö. A., Akhavan, S., & Zandi, S. (2022). Meaning-Making Coping With COVID-

19 in Academic Settings: The Case of Sweden. Illness, Crisis & Loss, 30(4), 770–794. https://doi.

org/10.1177/10541373211022002

Arslan, G., & Yıldırım, M. (2021). Meaning-Based Coping and Spirituality During the COVID-19 Pan-

demic: Mediating Effects on Subjective Well-Being. Frontiers in psychology, 12, 646572. https://doi.

org/10.3389/fpsyg.2021.646572

Burnette, J. L., Knouse, L. E., Vavra, D. T., O‘Boyle, E., & Brooks, M. A. (2020). Growth mindsets and psy-

chological distress: A meta-analysis. Clinical psychology review, 77, 101816. https://doi.org/10.1016/j.

cpr.2020.101816

Caneca Murcho, N. Á., & Palma Pacheco, J. E. (2020). Caracterização Do Burnout Em Profissionais De

Saúde Em Portugal: Um Artigo De Revisão. Psique, Journal of Research Centre for Psychology of the

Universidade Autonoma de Lisboa, 16(1), 8–23. https://doi.org/10.26619/2183-4806.XVI.1.4

Cetrez ÖA, Ahmadi F, Erbil P. (2020). A Comparative Survey Study on Meaning-Making Coping among

Cancer Patients in Turkey. Religions, 11(6):284. https://doi.org/10.3390/rel11060284

Cheng, C., Ying, W., Ebrahimi, O. V., & Wong, K. F. E. (2024). Coping style and mental health amid the first

wave of the COVID-19 pandemic: A culture-moderated meta-analysis of 44 nations. Health Psycho-

logy Review, 18(1), 141–164. https://doi.org/10.1080/17437199.2023.2175015

Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health

and Social Behavior, 24(4), 385–396. https://doi.org/10.2307/2136404

Counted, V., Pargament, K. I., Bechara, A. O., Joynt, S., & Cowden, R. G. (2022). Hope and well-being in

vulnerable contexts during the COVID-19 pandemic: Does religious coping matter? The Journal of

Positive Psychology, 17(1), 70–81.https://doi.org/10.1080/17439760.2020.1832247

DeRossett, T., LaVoie, D. J., & Brooks, D. (2021). Religious Coping Amidst a Pandemic: Impact on COVID-

-19-Related Anxiety. Journal of religion and health, 60(5), 3161–3176. https://doi.org/10.1007/s10943-

021-01385-5

du Toit, A., Thomson, R. & Page, A. (2022). A systematic review and meta-analysis of longitudinal studies

of the antecedents and consequences of wellbeing among university students. International Journal

of Wellbeing, 12(2), 163-206. https://doi.org/10.5502/ijw.v12i2.1897

Eisenbeck, N., Carreno, D. F., Wong, P. T. P., Hicks, J. A., María, R. G., Puga, J. L., Greville, J., Testoni, I.,

Biancalani, G., López, A. C. C., Villareal, S., Enea, V., Schulz-Quach, C., Jansen, J., Sanchez-Ruiz, M. J.,

Yıldırım, M., Arslan, G., Cruz, J. F. A., Sofia, R. M., Ferreira, M. J., García-Montes, J. M. (2022). An inter-

national study on psychological coping during COVID-19: Towards a meaning-centered coping style.

International journal of clinical and health psychology: IJCHP, 22(1), 100256. https://doi.org/10.1016/j.

ijchp.2021.100256

Fatima, S., Arshad, M., & Mushtaq, M. (2022). Religious coping and young adult’s mental well-being during

Covid-19: Testing a double moderated mediation model. Archive for the Psychology of Religion, 44(3),

158–174. https://doi.org/10.1177/00846724221121685

Fetzer, I. (2003). Multidimensional measurement of religiousness/spirituality for use in health research: A

report of the Fetzer Institute/National Institute on Aging Working Group. Kalamazoo, MI: John E. Fet-

zer Institute.

Fitzke, R. E., Marsh, D. R., & Prince, M. A. (2021). A longitudinal investigation of the meaning-making

model in midlife adults who have experienced trauma. Journal of clinical psychology, 77(12), 2878–

2893. https://doi.org/10.1002/jclp.23272

PSIQUE • e-ISSN 2183-4806 • Volume XX • Issue Fascículo 2 • 1st july julho-31st december dezembro 2024 • pp. 57-71

Kremena Mineva

Francis, B., Gill, J. S., Yit Han, N., Petrus, C. F., Azhar, F. L., Ahmad Sabki, Z., Said, M. A., Ong Hui, K., Chong

Guan, N., & Sulaiman, A. H. (2019). Religious Coping, Religiosity, Depression and Anxiety among

Medical Students in a Multi-Religious Setting. International journal of environmental research and

public health, 16(2), 259. https://doi.org/10.3390/ijerph16020259

Garssen, B., Visser, A., & Pool, G. (2021). Does spirituality or religion positively affect mental health?

Meta-analysis of longitudinal studies. The International Journal for the Psychology of Religion, 31(1),

4-20.

George, L. S., & Park, C. L. (2022). Do Violations of Global Beliefs and Goals Drive Distress and

Meaning Making Following Life Stressors? Illness, Crisis & Loss, 30(3), 378-395. https://doi.

org/10.1177/1054137320958344

Hayes, A. F. (2018). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-

-Based Approach (Methodology in the Social Sciences (2nd ed.). New York, NY: The Guilford Press.

Hill, P.C., Pargament, K.I., Hood, R.W., McCullough, J.,.M.E., Swyers, J.P., Larson, D.B. and Zinnbauer, B.J.

(2000), Conceptualizing Religion and Spirituality: Points of Commonality, Points of Departure. Jour-

nal for the Theory of Social Behaviour, 30, 51-77. https://doi.org/10.1111/1468-5914.00119

Keyes, C. L. M., & Martin, C. C. (2017). The complete state model of mental health. In M. Slade, L. Oades,

& A. Jarden (Eds.), Wellbeing, recovery and mental health (pp. 86–97). Cambridge University Press.

https://doi.org/10.1017/9781316339275.009

Keyes, C. L., Wissing, M., Potgieter, J. P., Temane, M., Kruger, A., & van Rooy, S. (2008). Evaluation of the

mental health continuum-short form (MHC-SF) in setswana-speaking South Africans.Clinical psy-

chology & psychotherapy,15(3), 181–192. https://doi.org/10.1002/cpp.572

Khazir Z, Jambarsang S, Abbasi-Shavazi M. (2019). The Study of General Health Status in the Students of

Shahid Sadoughi University of Medical Sciences in Yazd. J Community Health Research, 8(3): 131-138.

Krok, D., Zarzycka, B., & Telka, E. (2023). Risk Perception of COVID-19, Religiosity, and Subjective Well-

-Being in Emerging Adults: The Mediating Role of Meaning-Making and Perceived Stress. Journal of

Psychology and Theology, 51(1), 3-18. https://doi.org/10.1177/00916471221102550

Kryza-Lacombe, M., Tanzini, E., & O’Neill, S. (2019). Hedonic and eudaimonic motives: Associations with

academic achievement and negative emotional states among urban college students. Journal of

Happiness Studies: An Interdisciplinary Forum on Subjective Well-Being, 20(5), 1323–1341. https://doi.

org/10.1007/s10902-018-9994-y

Labrague, L. J., McEnroe-Petitte, D. M., Gloe, D., Thomas, L., Papathanasiou, I. V., & Tsaras, K. (2017). A

literature review on stress and coping strategies in nursing students. Journal of mental health, 26(5),

471–480. https://doi.org/10.1080/09638237.2016.1244721

Lachnit, I., Park, C. L., & George, L. S. (2020). Processing and Resolving Major Life Stressors: An Exami-

nation of Meaning-Making Strategies. Cognitive Therapy and Research, 44(5), 1015-1024. https://doi.

org/10.1007/s10608-020-10110-7

Lau, C. Y. H., & Tov, W. (2023). Effects of positive reappraisal and self-distancing on the meaningful-

ness of everyday negative events. Frontiers in psychology, 14, 1093412. https://doi.org/10.3389/

fpsyg.2023.1093412

Leipold, B., Munz, M., & Michéle-Malkowsky, A. (2019). Coping and resilience in the transition to adul-

thood. Emerging Adulthood, 7(1), 12–20. https://doi.org/10.1177/2167696817752950

Lloyd, Christina (2018). Moments of Meaning—Towards an Assessment of Protective and Risk Factors for

Existential Vulnerability among Young Women with Mental Ill-Health Concerns: A Mixed Methods

PSIQUE • e-ISSN 2183-4806 • Volume XX • Issue Fascículo 2 • 1st july julho-31st december dezembro 2024 • pp. 57-71

Predicting Well-being of Bulgarian University Students in Health Sciences:

The Role of Religious and Secular Meaning-Making Coping

Project in Clinical Psychology of Religion and Existential Health. Doctoral dissertation, Acta Universi-

tatis Upsaliensis, Uppsala, Sweden.

Mahamid, F.A., Bdier, D. (2021). The Association Between Positive Religious Coping, Perceived Stress, and

Depressive Symptoms During the Spread of Coronavirus (COVID-19) Among a Sample of Adults in

Palestine: Across Sectional Study. J Relig Health 60, 34–49. https://doi.org/10.1007/s10943-020-01121-5

Métais, C., Burel, N., Gillham, J. E., Tarquinio, C., & Martin-Krumm, C. (2022). Integrative Review of the

Recent Literature on Human Resilience: From Concepts, Theories, and Discussions Towards a Com-

plex Understanding. Europe’s journal of psychology, 18(1), 98–119. https://doi.org/10.5964/ejop.2251

Milman, E., Lee, S. A., Neimeyer, R. A., Mathis, A. A., & Jobe, M. C. (2020). Modeling pandemic depression

and anxiety: The mediational role of core beliefs and meaning making. Journal of affective disorders

reports, 2, 100023. https://doi.org/10.1016/j.jadr.2020.100023

Moussa, S., Malaeb, D., Barakat, M., Sawma, T., Obeid, S., Hallit, S. (2023).Association between Experien-

ces in Life and Quality of Life among Lebanese University Students in a Collapsing Country: The

Moderating Role of Religious Coping and Positivity. Healthcare. 11(1):149. https://doi.org/10.3390/

healthcare11010149

Negri, A., Conte, F., Caldiroli, C. L., Neimeyer, R. A., & Castiglioni, M. (2023). Psychological Factors

Explaining the COVID-19 Pandemic Impact on Mental Health: The Role of Meaning, Beliefs, and

Perceptions of Vulnerability and Mortality. Behavioral sciences), 13(2), 162. https://doi.org/10.3390/

bs13020162

Ortega-Maldonado, A., & Salanova, M. (2018). Psychological capital and performance among undergra-

duate students: the role of meaning-focused coping and satisfaction. Teaching in Higher Education,

23(3), 390–402. https://doi.org/10.1080/13562517.2017.1391199

Pankowski, D., & Wytrychiewicz-Pankowska, K. (2023). Turning to Religion During COVID-19 (Part II): A

Systematic Review, Meta-analysis and Meta-regression of Studies on the Relationship between Reli-

gious Coping and Mental Health throughout COVID-19. Journal of religion and health, 62(1), 544–584.

https://doi.org/10.1007/s10943-022-01720-4

Pargament, K. I. (1997). The psychology of religion and coping: Theory, research, practice. Guilford Press.

Park, C. L. (2011). Implicit Religion and the Meaning Making Model. Implicit Religion, 14(4), 405-419. https://

doi.org/10.1558/imre.v14i4.405

Park, C. L., & Folkman, S. (1997). Meaning in the context of stress and coping. Review of general psychology,

1(2), 115-144.

Park, C. L., Holt, C. L., Le, D., Christie, J., & Williams, B. R. (2018). Positive and Negative Religious Coping

Styles as Prospective Predictors of Well-Being in African Americans. Psychology of religion and spiri-

tuality, 10(4), 318–326. https://doi.org/10.1037/rel0000124

Park, C. L., & Kennedy, M. C. (2017). Meaning violation and restoration following trauma: Conceptual

overview and clinical implications. In E. M. Altmaier (Ed.), Reconstructing meaning after trauma:

Theory, research, and practice (pp. 17–27). Elsevier Academic Press. https://doi.org/10.1016/B978-0-

12-803015-8.00002-4

Paquin, V., Elgbeili, G., Laplante, D. P., Kildea, S., & King, S. (2021). Positive cognitive appraisal “buffers”

the long-term effect of peritraumatic distress on maternal anxiety: The Queensland Flood Study.

Journal of affective disorders, 278, 5–12. https://doi.org/10.1016/j.jad.2020.09.041

Pagán-Torres, O.M., Rosario-Hernández, E., González-Rivera, J.A., & Martínez-Taboas, A. (2021). The

mediating role of religious coping in perceived stress, psychological symptoms and psychological

PSIQUE • e-ISSN 2183-4806 • Volume XX • Issue Fascículo 2 • 1st july julho-31st december dezembro 2024 • pp. 57-71

Kremena Mineva

well-being in a sample of Puerto Rican adults. Spiritual Psychology and Counseling, 6(1), 29–46. https://

dx.doi.org/10.37898/spc.2021.6.1.133

Petagna, Kristen Diann. (2021).Making Sense of Acute Stress: Psychological Adjustment in Meaning

Making. Master’s Theses, Dissertations, Graduate Research and Major Papers Overview. 342. https://

digitalcommons.ric.edu/etd/342

Quek, T. T., Tam, W. W., Tran, B. X., Zhang, M., Zhang, Z., Ho, C. S., & Ho, R. C. (2019). The Global Preva-

lence of Anxiety Among Medical Students: A Meta-Analysis. International journal of environmental

research and public health, 16(15), 2735. https://doi.org/10.3390/ijerph16152735

Sisk, V. F., Burgoyne, A. P., Sun, J., Butler, J. L., & Macnamara, B. N. (2018). To What Extent and Under

Which Circumstances Are Growth Mind-Sets Important to Academic Achievement? Two Meta-A-

nalyses. Psychological Science, 29(4), 549-571. https://doi.org/10.1177/0956797617739704

Skalski-Bednarz, S. B., Konaszewski, K., Toussaint, L. L., Büssing, A., & Surzykiewicz, J. (2022). Positive

religious coping acts through perception of nature and silence in its association with well-being and

life satisfaction among Polish Catholics. Frontiers in Public Health, 10, 1020007.

Surzykiewicz, J., Skalski, S. B., Niesiobędzka, M., & Konaszewski, K. (2022). Exploring the mediating

effects of negative and positive religious coping between resilience and mental well-being. Frontiers

in behavioral neuroscience, 16, 954382. https://doi.org/10.3389/fnbeh.2022.954382

Somos, A. (2020). The impact of religious coping and resilience on psychological well-being among internatio-

nal students in Hungary [Dissertação de mestrado, Iscte - Instituto Universitário de Lisboa]. Repositó-

rio Iscte. http://hdl.handle.net/10071/21129

Wang, Y., Lippke, S., Miao, M. & Gan, Y. (2019). Restoring meaning in life by meaning-focused coping: The

role of self-distancing. Psych J, 8, 386-396. https://doi.org/10.1002/pchj.296

World Medical Association. (2013). World Medical Association Declaration of Helsinki ethical principles

for medical research involving human subjects. JAMA: Journal of the American Medical Association,

310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053

Wvs. (2023). Findings and Insights. The Inglehart-Welzel World Cultural Map, World Values Survey 7

(2023). http://www.worldvaluessurvey.org/

Yaden, D.B., Batz-Barbarich, C.L., Ng, V. et al. (2022). A Meta-Analysis of Religion/Spirituality and Life

Satisfaction. J Happiness Stud 23, 4147–4163 https://doi.org/10.1007/s10902-022-00558-7

Yang, Z., Ji, L. J., Yang, Y., Wang, Y., Zhu, L., & Cai, H. (2021). Meaning making helps cope with COVID-

19: A longitudinal study. Personality and individual differences, 174, 110670. https://doi.org/10.1016/j.

paid.2021.110670

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Predicting Well-being of Bulgarian University Students in Health Sciences:

The Role of Religious and Secular Meaning-Making Coping

TABLE1

Correlational matrix of variables of the study

1 2 3 4 5 6 7

1. SbWB -

2. SocWB .51*** -

3. PsWB .70*** .57*** -

4. PS -.61*** -.18** -.51*** -

5. PRC .15 * .34*** . 14** .09 -

6. NRC -.11 -.01 -.05 .11 -.04 -

7. SMMC .49*** .36*** .56*** -.33** .26*** -.06 -

Note: * - p < .05; ** - p <.01; *** - p < .001; SbWB- Subjective well-being; SocWB- Social well-being; PsWB- Psychological well-being; PS- Perceived

stress, PRC – Positive religious coping, NRC – Negative religious coping; SMMC- Secular meaning-making coping