Examining the effects of anxiety and education level on mental health: The role of spiritual intelligence as an intervening variable in post COVID-19 patients in Indonesia

2.1 Anxiety

Excessive concern, trepidation, and fear are hallmarks of anxiety, a common mental health condition that can have a serious negative influence on a person’s ability to function in everyday life and overall quality of life. According to research on the subject, anxiety can result from a complex interaction of hereditary, environmental, and psychological factors (Barlow, 2002). Anxiety disorders are among the most prevalent mental diseases globally, affecting over 18% of adult Americans alone, according to Kessler et al. (2005). Numerous research showing heightened anxiety symptoms due to health worries, social isolation, and economic difficulties have documented how the COVID-19 pandemic has further exacerbated anxiety levels globally (Rajkumar, 2020). Anxiety can take on multiple forms, such as panic disorder, social anxiety disorder, and generalized anxiety disorder, each with its own set of symptoms and difficulties. Research has demonstrated that cognitive-behavioral therapy (CBT) is a successful treatment for anxiety disorders, as it can effectively reduce symptoms and enhance coping mechanisms (Hofmann et al., 2012). While they may have adverse effects and need to be closely monitored, pharmacological therapies, such as selective serotonin reuptake inhibitors (SSRIs), are also frequently used to treat anxiety symptoms (Baldwin et al., 2014). According to Hofmann et al. (2010), recent research has examined the potential of mindfulness and relaxation practices as supplemental therapies, with an emphasis on their effectiveness in reducing anxiety. For those seeking therapy for anxiety, obstacles to care such as stigma and a lack of resources persist despite improvements in treatment. Research on anxiety must continue as our understanding of the problem advances in order to create more approachable and efficient interventions for those who suffer from this widespread illness.

2.2 Education level

It has long been known that an individual’s educational level has a substantial impact on their resilience, coping mechanisms, and resource accessibility, all of which are related to their mental health. Higher educational level is regularly linked to better mental health outcomes because it frequently gives people the tools they need to think critically, solve problems more effectively, and comprehend a wider range of health-related information (Mirowsky & Ross, 2003). These abilities can improve a person’s capacity to deal with difficult situations and find resources, which can result in an increase in psychological well-being (Ross & Wu, 1995). Additionally, education gives people access to social and economic possibilities that might lower stress and anxiety, which promotes an atmosphere that is more stable for mental health (Burgard & Lin, 2013). On the other hand, those with less education could have trouble getting mental health care because they don’t know about or comprehend the resources that are accessible to them. This can make them feel even more stressed and helpless (Zajacova et al., 2015). These differences have been brought to light even more by the COVID-19 pandemic, as people with lower educational level have found it more difficult to adjust to distant work and learning environments, which has led to an increase in mental health stresses (Patrick et al., 2020). Comprehending the influence of educational level on mental health is crucial in order to formulate focused measures and regulations that tackle these discrepancies and encourage fair and equal availability of mental health services to individuals from diverse educational backgrounds.

2.3 Spiritual intelligence

The ability to find meaning, purpose, and connection in life is referred to as spiritual intelligence, and it has come to be recognized as a significant element impacting mental health. The capacity to uphold inner calm, exhibit empathy, and exhibit perseverance in the face of difficulty are characteristics of this type of intellect (Zohar & Marshall, 2000). Studies reveal that people with high spiritual intelligence typically have lower rates of anxiety and depression because they are better able to handle stress and difficulties because they have a stronger sense of purpose and connectivity (Vaughan, 2002). A holistic perspective of life’s experiences is facilitated by spiritual intelligence, which enables people to see challenges as chances for personal development rather than insurmountable roadblocks (Emmons, 2000). Additionally, research has demonstrated that spiritual intelligence can increase emotional regulation, which can minimize unpleasant feelings and improve psychological well-being (King & DeCicco, 2009). Spiritual practices that are components of spiritual intelligence, such mindfulness and meditation, have been demonstrated to considerably reduce stress and produce a positive mental state in the context of mental health (Seybold & Hill, 2001). Growing research on spiritual intelligence and its advantages provide a possible path for creating therapies that integrate existential and spiritual elements into therapeutic modalities to address mental health concerns.

2.4 Mental health

An essential part of total wellbeing, mental health includes social, psychological, and emotional dimensions that affect people’s thoughts, feelings, and behaviors. It is essential for managing stress, interacting with people, and making decisions at different phases of life (World Health Organization, 2001). Millions of people worldwide suffer from mental health illnesses, which can have a significant negative influence on an individual’s productivity and quality of life. These disorders include conditions like depression, anxiety, and schizophrenia (Kessler et al., 2005). The stigma attached to mental illness frequently prevents people from getting treatment, which increases the burden of these disorders (Corrigan, 2004). Prevention, early intervention, and access to suitable treatment services are all essential components of a comprehensive strategy for providing effective mental health care (Patel et al., 2016). Various mental health issues have been demonstrated to be effectively managed by psychotherapy, medication, and lifestyle therapies such exercise and mindfulness techniques (Cuijpers et al., 2016). Furthermore, a growing body of research underscores the significance of socioeconomic determinants, including wealth, education, and community support, in shaping mental health outcomes and stresses the necessity of policies that take these elements into account (Marmot, 2005). There is a growing need for comprehensive strategies that integrate mental health into public health agendas in order to improve mental health outcomes worldwide and lessen the stigma and barriers associated with seeking care, as awareness and understanding of mental health issues continue to rise.

2.5 The effect of anxiety on spiritual intelligence and mental health

Pervasive sensations of anxiety and fear are the hallmark of anxiety, which can have a major impact on mental health and spiritual intelligence, among other elements of psychological functioning. Studies have indicated a correlation between elevated anxiety levels and heightened mental health conditions, including emotional discomfort and depression (Rathakrishnan et al., 2022). Furthermore, spiritual intelligence—which includes the ability to find purpose in life, preserve inner calm, and demonstrate empathy—can be impacted by anxiety.

The relationship between anxiety and mental health may be mediated by spiritual intelligence. People who possess strong spiritual intelligence may be better able to control their anxiety because of their increased emotional intelligence, resilience, and capacity to find purpose in difficult circumstances. The detrimental effects of anxiety on mental health may be lessened by this buffering effect. According to Rathakrishnan et al. (2022), spiritual intelligence can improve mental health outcomes by reducing the negative impacts of anxiety.

2.6 The effect of educational level on spiritual intelligence and mental health

Higher levels of spiritual intelligence can be attributed to improved cognitive and emotional growth, which is correlated with educational level. Putra’s (2016) research revealed a favorable correlation between parents’ educational level and their children’s spiritual intelligence, implying that education can promote spiritual development and comprehension. Higher education can give people the skills and understanding needed to develop spiritual practices and awareness.

Furthermore, there is a strong correlation between mental health outcomes and educational level. Better employment opportunities, financial security, and access to healthcare are all benefits of higher education that can enhance mental health. According to studies by Taple et al. (2022), Raghupathi & Raghupathi (2020), and Namira & Yuliawati (2021), having more education is associated with improved mental health since it gives one access to more resources and support networks. On the other hand, a lack of education can limit one’s ability to utilize these resources, which can result in more stress and worse mental health consequences.

2.7 The effect of spiritual intelligence on mental health

Spiritual intelligence, which involves the ability to find meaning and purpose in life, maintain inner peace, and exhibit empathy and compassion, is proposed to influence mental health outcomes. The relationship between spiritual intelligence and mental health has been explored in various studies, revealing both supportive and conflicting results. Research by Rathakrishnan et al. (2022) and Wahyuni & Bariyyah (2019) suggests that higher levels of spiritual intelligence are positively associated with better mental health. These studies indicate that spiritual intelligence can help individuals manage stress, anxiety, and other mental health challenges by providing a sense of purpose and resilience.

In contrast, Furqani (2021) found that spiritual intelligence did not have a significant relationship with mental health, highlighting a potential discrepancy in the literature. This conflicting result underscores the need for further investigation into how spiritual intelligence may affect mental health and whether this relationship varies across different contexts or populations. The research gap identified from these differing findings suggests that while spiritual intelligence may generally support mental health, the effect might not be uniform across all studies. Thus, we hypothesize:

4.1 Demographic respondent

Demographic data in Table 1 provides a detailed breakdown of the participants’ characteristics, allowing for a comprehensive understanding of the diverse group surveyed. The data spans various categories including gender, age, education, the year of infection with COVID-19, and employment status, offering insights into the demographic distribution and contextual background of the individuals involved.

The demographic data presented offers a detailed overview of the participants’ characteristics across various categories including sex, age, education, the year of infection with COVID-19, and occupation. The sample consists of 390 participants with a distribution skewed towards female respondents, who make up 73% of the total (286 individuals), compared to 27% male participants (104 individuals). Age-wise, the group is mostly concentrated between 23 and 37 years, with 59 participants (15%) aged 23-27 years, 85 participants (22%) aged 28-32 years, and 95 participants (24%) aged 33-37 years. The remaining age groups gradually decrease in representation with the lowest numbers in the 53-67 years range.

Educational levels among the participants vary, with the majority holding a Senior High School diploma (230 participants, 59%), followed by those with a Bachelor’s degree (112 participants, 29%). Fewer participants have attained a Master’s (17 participants, 4%) or Doctoral degree (3 participants, 1%). Regarding the year of COVID-19 infection, a significant number were infected in 2021 (192 participants, 49%), followed closely by those infected in 2020 (97 participants, 25%) and 2019 (95 participants, 24%).

Occupationally, the participants are diverse, with factory workers and homemakers each comprising 19% of the total. Other notable occupations include self-employed (35 participants, 9%), students (19 participants, 5%), and private sector employees (25 participants, 6%). The rest are distributed among various jobs including teachers, freelancers, and civil servants, reflecting a wide range of employment statuses within the group. This diverse demographic composition provides a rich dataset for analyzing the impacts and correlates of various socio-economic factors.

4.2 Measurement model

The measurement model evaluates the reliability and validity of the constructs: Anxiety (X1), Educational Level (X2), Spiritual Intelligence (Z), and Mental Health (Y). Each construct is measured using specific scales, and the reliability and validity of these measurements are tested through various criteria.

The measurement model analysis in Table 2 demonstrated that the constructs used in the study—Anxiety, Educational Level, Spiritual Intelligence, and Mental Health—are both reliable and valid. Each construct showed high internal consistency, with Cronbach’s alpha values exceeding 0.70 and composite reliability values above 0.80. The Average Variance Extracted (AVE) for all constructs surpassed the 0.50 threshold, indicating adequate convergent validity. Moreover, discriminant validity was confirmed as the square root of the AVE for each construct was greater than its highest correlation with any other construct, ensuring distinctiveness among the constructs. These results confirm that the measurement scales used for Anxiety, Educational Level, Spiritual Intelligence, and Mental Health are robust, providing a reliable and valid foundation for further analysis in the structural model.

4.3 Structural model

The structural model presented in the Figure 2 and Table 3 illustrates the relationships among Anxiety (X1), Educational Level (X2), Spiritual Intelligence (Z), and Mental Health (Y). The model employs path coefficients to demonstrate the strength and direction of these relationships.

Figure 2. Result of hypothesis testing model.

Anxiety (X1) has a significant positive direct effect on Spiritual Intelligence (Z), with a path coefficient of 0.561, a T-Statistic of 4.742, and a p-value of 0.000. This indicates that higher levels of anxiety are significantly associated with higher levels of spiritual intelligence. While this result may seem counterintuitive, it is possible that individuals experiencing anxiety may actively seek coping mechanisms, such as spiritual practices, to manage their distress, which may, in turn, elevate their spiritual intelligence. This could also indicate a reverse causality where individuals with heightened spiritual awareness are more sensitive to existential concerns, thereby experiencing higher anxiety levels. However, Anxiety has a significant negative direct effect on Mental Health (Y), with a path coefficient of -0.249, a T-Statistic of 3.999, and a p-value of 0.000. This suggests that higher anxiety levels are associated with poorer mental health outcomes.

Educational Level (X2) has a moderate positive effect on Spiritual Intelligence (Z), with a path coefficient of 0.242, a T-Statistic of 2.667, and a p-value of 0.010. This indicates that higher educational levels are significantly associated with higher spiritual intelligence. Educational Level also positively affects Mental Health (Y), with a path coefficient of 0.332, a T-Statistic of 2.597, and a p-value of 0.013. This shows that higher educational levels are associated with better mental health outcomes.

Spiritual Intelligence (Z) has a strong positive effect on Mental Health (Y), with a path coefficient of 0.734, a T-Statistic of 5.342, and a p-value of 0.000. This underscores the crucial role of spiritual intelligence in enhancing mental health, indicating that individuals with higher spiritual intelligence tend to have better mental health outcomes.

The model also examines the indirect effects of Anxiety (X1) and Educational Level (X2) on Mental Health (Y) through Spiritual Intelligence (Z). The indirect effect in Table 4 of Anxiety on Mental Health through Spiritual Intelligence is significant, with a calculated effect of 0.412 (0.561 * 0.734), indicating that higher levels of anxiety contribute to better mental health indirectly by enhancing spiritual intelligence. Similarly, the indirect effect of Educational Level on Mental Health through Spiritual Intelligence is also significant, with a calculated effect of 0.178 (0.242 * 0.734), suggesting that higher educational levels improve mental health indirectly by increasing spiritual intelligence. These significant indirect effects highlight the mediating role of spiritual intelligence in the relationship between anxiety, educational level, and mental health.

The summary Table 5 below presents the direct, indirect, and total effects of the variables on each other within the model:

The direct effect of Anxiety (X1) on Spiritual Intelligence (Z) is 0.561, while the direct effect of Educational Level (X2) on Spiritual Intelligence is 0.242. Both of these effects are significant, indicating that higher anxiety and higher educational levels lead to increased spiritual intelligence. For the relationship between Anxiety and Mental Health (Y), the direct effect is -0.249, suggesting a negative impact. However, when considering the indirect effect through Spiritual Intelligence (0.412), the total effect of Anxiety on Mental Health is 0.163, highlighting a net positive impact due to the mediation by spiritual intelligence.

Educational Level (X2) has a direct positive effect on Mental Health (0.332), and with an additional indirect effect through Spiritual Intelligence (0.178), the total effect on Mental Health is 0.510, emphasizing the substantial positive influence of education on mental health. Lastly, the direct effect of Spiritual Intelligence on Mental Health is notably strong at 0.734, reaffirming its crucial role in promoting better mental health outcomes.

In summary, the results indicate significant relationships among anxiety, educational level, spiritual intelligence, and mental health, supporting the study’s hypotheses. The positive relationship between anxiety and spiritual intelligence, while somewhat unexpected, may indicate that individuals under psychological distress seek meaning or spiritual support as a coping mechanism, indirectly enhancing their resilience. The findings reinforce the crucial role of spiritual intelligence in mental health, suggesting it as an effective focus for mental health interventions, especially in post-COVID-19 contexts.

5.1 The effect of anxiety on spiritual intelligence and mental health

Our findings support the hypothesis that anxiety has a significant impact on both spiritual intelligence and mental health. The positive relationship between anxiety and spiritual intelligence, while counterintuitive, suggests that individuals experiencing heightened anxiety may turn to spiritual practices or seek deeper meaning as coping mechanisms to alleviate distress. This result is consistent with the findings of Rathakrishnan et al. (2022) and Jamshidi et al. (2017), which suggest that anxiety can positively influence the development of spiritual intelligence as individuals seek psychological resilience through spiritual engagement. Given that most of the sample consists of younger and female participants, this relationship could reflect coping preferences commonly observed within these demographics, where spiritual and emotional support are often sought in response to psychological distress.

However, previous studies (Khoshdeli et al., 2020; Mohammadipour et al., 2021; Safavi et al., 2019) have reported a negative and significant impact of spiritual intelligence on anxiety, suggesting that higher spiritual intelligence is associated with lower anxiety levels. This discrepancy could be due to variations in cultural contexts, measurement approaches, or specific dimensions of spiritual intelligence assessed in different studies. Additionally, the possibility of reverse causality should be considered—heightened spiritual awareness may lead to increased existential reflection, which in some individuals could elevate anxiety levels rather than alleviate them.

Furthermore, anxiety’s negative impact on mental health is evident, emphasizing the need for interventions that address both direct and indirect effects of anxiety. Spiritual intelligence appears to buffer some of these negative impacts by promoting emotional resilience and a sense of purpose, thereby helping to reduce the detrimental effects of anxiety on mental well-being. This suggests that integrating spiritual development practices in mental health treatments for anxiety could offer protective effects. Practices like mindfulness, meditation, and spiritual counseling could support individuals in finding purpose, thus potentially reducing the adverse effects of anxiety on mental health. This approach aligns with the buffering theory of Rathakrishnan et al. (2022), which proposes that spiritual intelligence enhances emotional resilience, mitigating the harmful effects of anxiety.

5.2 The effect of educational level on spiritual intelligence and mental health

Spiritual intelligence and mental health are strongly influenced by educational level. Increased cognitive and emotional growth is probably the reason why higher educational attainment is associated with increased spiritual intelligence. This confirms Putra’s (2016) findings that learning promotes understanding and spiritual growth. Additionally, studies by Taple et al. (2022), Raghupathi and Raghupathi (2020), and Namira and Yuliawati (2021) that highlight the advantages of higher education in providing access to better employment opportunities, financial security, and healthcare, tend to support the idea that people with higher educational levels also tend to have better mental health outcomes. Education thus serves as a foundation for developing spiritual intelligence, equipping individuals with the knowledge and skills needed to cultivate spiritual awareness and practices, which positively impact mental health.

The significant influence of education on spiritual intelligence and mental health highlights the importance of educational policies that promote mental well-being. Incorporating curricula that support spiritual as well as cognitive and emotional development could be particularly beneficial for younger populations, as seen in this study. Programs that foster empathy, ethical reasoning, and critical thinking could enhance students’ spiritual intelligence and, in turn, their mental health. This approach supports findings from Taple et al. (2022), Raghupathi and Raghupathi (2020), and Namira and Yuliawati (2021), which show how education can enhance mental health outcomes by giving people better access to resources and support systems.

5.3 The effect of spiritual intelligence on mental health

Spiritual intelligence plays a critical role in promoting positive mental health outcomes. Individuals with high levels of spiritual intelligence are generally better equipped to manage stress and anxiety, which contributes to improved mental health. This result is consistent with studies by Wahyuni and Bariyyah (2019) and Rathakrishnan et al. (2022), which indicate that spiritual intelligence supports people in exhibiting empathy and compassion, finding meaning and purpose in life, and preserving inner peace—all of which are factors that positively impact mental health. Given that the sample primarily consists of younger and female participants, this strong relationship between spiritual intelligence and mental health may align with the supportive and meaning-seeking characteristics often observed in these groups. However, it is essential to note Furqani (2021) findings, which indicated variability in this relationship among different groups, suggesting that the impact of spiritual intelligence on mental health may depend on cultural or demographic factors.

The substantial positive correlation between spiritual intelligence and mental health bears important implications for interventions aimed at promoting mental health. Policymakers and mental health professionals could consider incorporating spiritual intelligence development into their programs. For instance, interventions aimed at helping individuals find purpose, maintain inner calm, and develop empathy could enable them to better cope with stress and anxiety. This is consistent with the favorable results reported by Wahyuni and Bariyyah (2019) and Rathakrishnan et al. (2022), which suggests that spiritual intelligence can be an effective means of fostering mental wellness. Notwithstanding the inconclusive results reported by Furqani (2021), it is imperative to customize these initiatives to particular cultural and demographic settings in order to guarantee their efficacy.