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19 June 2023

Associations between Prayer and Mental Health among Christian Youth in the Philippines

,
and
1
Department of Theology and Religious Education, De La Salle University, Manila 0922, Philippines
2
School of Innovation & Sustainability, De La Salle University, Binan 4024, Philippines
3
Research Unit, Lumina Foundation for Integral Human Development, Calamba 4027, Philippines
4
Centre for Spirituality, Theology and Health, Duke University, Durham, NC 27710, USA
Religions2023, 14(6), 806;https://doi.org/10.3390/rel14060806
This article belongs to the Special Issue The Role of Religion and Spirituality in Times of Crisis
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Abstract

Religion/Spirituality (R/S) has been associated with mental health. Although most Filipinos are Christian, little research has been done on how R/S affects their mental health. To address this research gap, an open-ended questionnaire was conducted on forty-three Filipino Christian youths regarding their thoughts, motives, and emotions about private prayer. Responses were coded and analyzed with the qualitative data analysis software NVivo. A traditional coding method was also employed to contextualize the data. Results show that most respondents define prayer as a way to communicate with God and personally encounter the transcendent. In general, prayer was used to express gratitude, request something, seek guidance, ask for forgiveness, or find psychological comfort. In most cases, participants prayed when they were feeling down or troubled. The majority prayed in silence and with their eyes closed. Most respondents felt calm and relaxed when praying. Many respondents also noted that their conversation with God provided comfort, reassurance, and relief. A theoretical model of causal pathways for the effects of prayer on mental health was used to examine how Filipino Christian youths’ emotional health—a component of mental health—is affected by prayer. Research suggests that prayer guides many respondents in their decisions and life choices. Prayer also may evoke human virtues, such as gratitude, patience, and honesty. For many, prayer is critical to their cognitive appraisal of stressful events and serves as a coping resource. This study has important implications for R/S as a resource for mental well-being among youth in a country with limited mental health services.

1. Introduction

The World Health Organization () defines mental health as “a state of mental well-being that enables people to cope with the stresses of life, to realize their abilities, to learn well and work well, and to contribute to their communities” (p. 8). Globally, mental health conditions are highly prevalent. The () estimates that one in eight people live with a mental disorder, the most common of which are anxiety and depression. Also, the suicide rate among young people is alarmingly high (p. xv). Although the () has urged for a transformation in mental health (p. vii), the development of mental health services in most low- and middle-income countries (LMIC) has been slow (). Due to the inextricable link between mental health and poverty, countries that neglect mental health can trap people in a vicious cycle that prevents them from achieving a better life ().
In the Philippines, mental health issues pose a significant challenge (World Health Organization Regional Office for the Western Pacific—). Anxiety and depression are the most common mental health issues among Filipinos (; ). Also, suicide rates, particularly among the youth, are increasing (; ). According to the (), non-health sectors, such as education, employment, judiciary, housing, and social welfare, can contribute to mental health promotion, protection, and care (p. 30). In this paper, the researchers propose religion/spirituality (R/S) as a potential resource for mental health. Numerous qualitative studies have shown that R/S improves mental health and well-being. Also, many cross-sectional and longitudinal studies demonstrate that people who are more religious or spiritual have better mental health. Moreover, R/S interventions reduce psychological distress in randomized controlled trials ().
The Christian doctrine was introduced to the Philippines in 1521 at the onset of the Spanish conquest, and was deeply embedded into Filipino culture (). Among Asian countries, the Philippines has the largest Christian population (). Filipinos number around 109 million (), with almost 80 percent professing the Roman Catholic faith (; ). The Philippines is the world’s third-largest Catholic population (), and Christianity is flourishing in the country (). Consequently, Catholicism is integral to Filipino culture, society, and politics (). Catholic ideas and expressions influence Filipinos’ sociocultural norms and their daily lives (). However, religion in the Philippines is not monolithic. Various religious beliefs exist in Filipino society, including, but not limited to, Christian denominations, Islam, Buddhism, and Sikhism. Some indigenous Filipinos have also appropriated and re-imagined Christianity (). Interreligious dialogues grounded in the Filipino value of pakikipagkapwa (fellowship) contribute to community building and social cohesion, and they provide meaning to religious actors under challenging conditions ().
Recent surveys show that most Filipinos consider religion essential in their lives (; ). Also, studies on the centrality of religiosity confirm that many Filipinos have a profound religious life (, , ). Some studies on R/S in the Filipino context point to the positive contributions of R/S to the mental health of Filipinos. Many Filipino youths report that R/S helps them to cope with life’s challenges (). Moreover, spiritual Filipino youths manifest a grateful attitude, increasing their life satisfaction (). Also, Filipino youth who have higher levels of R/S experience better relationships, academic success, and well-being (). In addition, some Filipino women use spirituality to reinterpret adverse events, set meaningful goals, and make decisions (). Also, some elderly Filipinos who live in institutional facilities run by religious orders are more spiritual and less anxious about death ().
Religion is a multidimensional construct (; ). Among Filipino youth, those whose faith plays an influential role in their lives demonstrate their religiosity primarily through ideology and private practice (, , ). This private practice of religion refers to personal prayers to God or the transcendent (). The studies mentioned earlier on R/S and mental health confirm that “the workings of the spirit are related to well-being” ().

Objectives of the Study

Currently, there is a plethora of empirical research on the effects of prayer on mental health (; ; ; ; ; ). However, in the Philippines, limited studies examine the relationship between prayer and the mental health of Filipino youth. This paper addresses this lacuna by examining how private prayer affects youths’ emotional health in a predominantly Christian lower-middle-income country. The authors hypothesize that prayer fosters positive emotions among select Filipino Christian youth, which can benefit their mental health.
Hence, this study aims to broaden the understanding of how R/S contributes to the mental health of Filipino Christian youth. In this paper, religion refers to “beliefs, practices, and rituals related to the transcendent. It is a multidimensional construct that includes beliefs, behaviors, rituals, and ceremonies that may be held or practiced in private or public settings but are in some way derived from established traditions that developed over time within a community [of believers]” (). The definition of spirituality is “very similar to religion” (). Spirituality traditionally refers to living a life dedicated to the divine (). However, in contemporary understanding, “spirituality is considered personal and something the individuals define for themselves. It is often free of rules, regulations, and responsibilities associated with religion” ().
Although religiosity has multiple dimensions (; ) and mental health exists on a complex continuum (), this study examines only one dimension of religiosity and its effect on a component of mental health. This paper investigates select Filipino Christian youths’ notions, motives, and emotions regarding private prayer. It hopes to look at the healthy development of religiosity/ spirituality as a personal journey towards self-realization (). More importantly, it aims to answer the question, “How does private prayer contribute to the mental health of select Filipino Christian youth?”.

2. Review of the Literature

2.1. Perspectives about Prayer

In recent years, prayer and its utilization have been the subject of controversy. A number of recent studies have explored the relationship between prayer and health (). Several perspectives indicated that prayer is a personal communication between an individual and God (). It is a multidimensional phenomenon involving materialistic petition, rest, confession, intercession for others, and using rituals and traditions as guides (). Empirical studies show that prayer can foster mental health among Christians. Some Filipino American Catholics with mental health issues feel relief and support when they pray. Even before seeking professional assistance, they manage their mental health challenges through faith (). Among select Catholic students in Northern Ireland, prayer frequency was positively associated with psychological health. Additionally, higher levels of prayer were associated with lower psychoticism scores ().
In the Roman Catholic tradition, prayer refers to raising one’s mind and heart to God, or asking for good things from Him (). Through prayer, Christians deepen their union with the Trinitarian God (). In prayer, Christians ask God for increased virtues, such as humility, mercy, patience, kindness, fortitude, or prudence (). In addition, prayer can ease anger, sustain love, multiply joy, and give Christians the strength to forgive (). The Catholic Church recognizes the benefits of communicating with God, especially for people overwhelmed with daily life. As () explains, “prayer, the words of Jesus, and psychological counseling can assist those who are weary and burdened and vulnerable to mental illness”.
Moreover, among select Roman Catholic congregants in Silicon Valley, centering prayer fostered a personal relationship with God, where rest and healing were found (). In addition, many Catholic pastoral workers experience the transcendent through prayer. Their inner experience of the transcendent promotes their psychosomatic health and well-being ().
Studies also show that prayer helps individuals deal with negative emotions () and negative life experiences (). In Catholic primary schools in New South Wales, Australia, many students use prayer to diffuse and manage their emotions, particularly anger, stress, and frustration (). In Spain, some middle-aged Catholics report that their anxious and fatigued mood state has improved after reciting the Jesus Prayer (). In Brazil, some Catholics utilize prayer as a coping strategy. By praying, they reduce anxiety and find meaning and purpose in their lives (). Further, research on the reciprocal relationship between R/S and positive emotions (PEs) suggests that many people who pray feel gratitude and awe. An individual’s psychological well-being is enhanced by such PEs ().

2.2. A Theoretical Model of the Causal Pathway of Prayer for Mental Health

() offers a theoretical model of causal pathways for mental health (MH) based on Western monotheistic religions (hereafter referred to as the “R/S causal pathways for MH model”). Religious individuals believe in a transcendental force that cares for humans and responds to their needs. They also demonstrate their faith and commitment to the transcendent through organizational, non-organizational, and subjective or intrinsic religiosity (). Furthermore, religious adherents can be influenced by their religion’s rules and regulations (doctrines) when it comes to living their life and treating others in a social group. A religious person who follows such rules and regulations reduces the likelihood of stressful life events that reduce positive emotions and increase negative ones. It is also possible for religious individuals to be urged by their religion to practice human virtues, which can increase positive emotions and neutralize negative ones. Religious individuals, therefore, benefit from their powerful conceptualizations of transcendent and religious commitment, as they can make their adverse life events seem less distressing by influencing their cognitive appraisals (). Adapting ’s () “R/S causal pathways for MH model”, this paper proffers a causal pathway of private prayer for emotional health (see Figure 1).
Figure 1. Causal pathway linking private prayer to emotional health. Adapted from () “Theoretical model of causal pathways for mental health (MH), based on Western monotheistic religions (Christianity, Judaism, and Islam)”.

2.3. Prayer Life Experiences of Filipino Christian Youth

In the Philippines, around 90% of Filipino Catholics affirm the importance of prayer (). () found that many Filipino Catholic youths are devoted to daily prayer and meditation. However, only a few read the Bible, pray the Rosary, and visit the Blessed Sacrament (p. 131). () confirm ’s () findings about the importance of private prayer among religiously involved youth. During significant life experiences that cause moral and physical suffering, many Filipino Catholic youths pray to God to forgive their sins and seek his help and care (). Thus, private prayer for many Filipino Catholic youths is a way to communicate with God, and serves as a positive religious coping resource.
The select Filipino Christian youth demonstrate their belief in God through private prayer. In private prayer, they communicate their life experiences to the transcendent. Their conversation with God guides their decisions and choices in life. Prayer also evokes human virtues among religious youth, which, when applied to daily life, can improve their social relations or compel them to provide social support to others. Prayer elicits positive emotions, serving as a coping resource during difficult life circumstances. It is also essential to the cognitive appraisal of stressful events. Hence, prayer contributes to their positive emotional health, which is integral to their mental health.

3. Methodology

Demographics and Procedure

An open-ended questionnaire was conducted among a convenience sample of forty-three Filipino Christian college students at a Christian university in the Philippines. There were sixteen female and twenty-seven male participants, aged nineteen to twenty-two years old. Ninety percent of the respondents were Catholic, and the remaining were from other denominations (See Table 1).
Table 1. Participant Demographic Characteristics.
The survey was conducted using online Google forms from September to October 2020. Participants were asked five open-ended questions about prayer: (1) What is prayer?; (2) Why do you pray?; (3) When do you pray?; (4) How do you pray?; and (5) What do you feel when you pray?. The respondents were informed that participating in the study was voluntary, confidential, and involved no risk or harm. In addition, other ethical considerations and information were provided. The participants knew they could withdraw at any time during the survey. Questionnaires were only given to participants who gave their informed consent. Participation was voluntary, and payment or extra credit was not used as an incentive. Participants completed the survey questionnaires individually.
The responses were coded and analyzed using the qualitative data analysis (QDA) software NVivo. In the data analysis, the data were categorized into nodes, or themes. Reading the text, highlighting key sections, and assigning sequential codes to these sections were all part of the process. The annotations in NVivo also captured analytical questions and reflections. A digital link was established between NVivo code memos and associated data. All codes developed were reviewed and grouped according to their similarity in concepts. The codes provided insight into the notions, motivations, and emotions of select Filipino Christian youth regarding prayer. Since the data generated by NVivo can be de-contextualized and disembodied (), the researchers also analyzed the responses of select Filipino Christian youth using traditional coding tools, such as colored pens, paper, and sticky notes, to contextualize the data. The multimodality forms of data interaction (i.e., data analysis using software and traditional methods and tools) maximized researcher data interaction and ensured the analysis process was rigorous and productive (). The method also provided nuance and allowed the researchers to ground the potential causal pathway linking private prayer to mental health in empirical evidence.

4. Results and Discussion

4.1. Contextualized Data on Prayer

As a result of analyzing the data using NVivo, five themes emerged regarding the perspectives of Filipino Christian youth on prayer: (1) definition of prayer; (2) purpose of prayer; (3) circumstances or periods of prayer; (4) manner of prayer; and (5) prayer-related emotions (See Table 2, Table 3, Table 4, Table 5 and Table 6). Most respondents mentioned that their decisions and choices are guided by their conversations with God. Some of the responses were:
“I pray to him when I need his advice or guidance, especially when I am having trouble”.
(Female 3: ORD)
“I also pray a lot when I have lots of problems to ask for guidance and strength to overcome my problems”.
(Female 9: CATH)
“I would also pray whenever I feel lost and need guidance from the Lord”.
(Male 18: CATH)
“I usually pray when I need guidance for a particular situation”.
(Male 24: CATH)
Table 2. Definition of Prayer.
Table 3. Purpose of Prayer.
Table 4. Circumstances or Periods of Prayer.
Table 5. Manner of Praying.
Table 6. Prayer-related Emotions.
The respondents also report that prayer evokes various human virtues in them. They are grateful, patient, and honest when they pray. In addition, the respondents mentioned that prayer enables them to cope with stress and elicits positive emotions in them. Some of the responses were:
“After praying, I feel a bit of weight lifted off my shoulders”.
(Female 13: CATH)
“Whenever I am praying, I feel empowered and am reminded that I am not alone whatever obstacle I encounter as I go along my path”.
(Female 1: CATH)
“I feel a sense of protection and love whenever I start praying as I feel God’s presence”.
(Male 9: CATH)
“After praying, sometimes I feel relieved, hopeful, at peace”.
(Male 11: CATH)
“When I pray, I usually try to visualize myself in a sort of safe space just for God and me, which gives me this comfort I was talking about as well as happiness because of the opportunity I am given to talk to Him”.
(Male 1: ORD)
For most respondents, prayer is a way to communicate with God. Some define prayer as an encounter with the transcendent on a personal level. A few confirm that praying manifests faith, loyalty, and worship of God. Furthermore, prayer is a spiritual act (see Table 2). It is a two-way relationship between man and God, so praying involves talking and listening to God. Most of the respondents pray to express gratitude to God. Many pray to request help or a favor. Some engage in prayer to seek guidance, ask for forgiveness, and receive psychological comfort from God. Many select Filipino Christian youth pray when feeling down or troubled (see Table 3). They usually pray at the end of the day and before meals. A small number mentioned that they pray at Mass. A few respondents mentioned that prayer could be done anywhere and at any time. Some also report that they pray during significant life events. In general, the respondents pray in silence. Their prayers are spontaneous. Some make the sign of the cross before and after praying. They usually close their eyes and follow a particular order when they pray—thanksgiving first, then petition (see Table 4).
Furthermore, some respondents follow the ACTS (adoration, confession, thanksgiving, supplication) prayer method (see Table 5). In addition, many respondents report feeling light, calm, and relaxed when praying. Some respondents’ conversation with God gives them a sense of security, reassurance, and relief. Also, a few individuals report feeling God’s presence when they pray. Lastly, for some respondents, prayer is a source of happiness and fulfillment (see Table 6).

4.2. Potential Causal Pathway Linking Private Prayer to Mental Health among Select Filipino Christian Youth

In addition to exploring the notions, motivations, and emotions associated with prayer, this study sought to answer the question, “How does prayer contribute to the emotional health of Filipino Christian youth?”. According to ’s () “R/S causal pathways for MH model”, there are three predominant mechanisms by which R/S can influence mental health. First, most religions have rules and regulations (doctrines) about living and treating others within a social group. Second, religion promotes virtues that help to maintain and enhance social relationships. Third, religion provides resources for coping with stress, which may increase the frequency of positive emotions (p. 7). Taking this into account, the researchers developed a preliminary model of private prayer’s causal pathway for mental health. In the model, three predominant mechanisms of prayer’s influence on emotional health were plotted (see Figure 2). The model shows that the select Filipino Christian youth talk and listen to God in times of distress. Through prayer, they seek guidance from the transcendent. Moreover, prayer cultivates virtues, such as patience and honesty, in them. Also, prayer induces positive emotions, such as calmness, relaxation, relief, and joy. In addition, their prayer alleviates the negative emotional consequences of stressful life circumstances, since they believe that God will help and protect them. The openness to transcendence allows the person to find meaning in life and understand the self (). In turn, these mechanisms promote positive emotional health, which positively affects individuals’ mental wellness.
Figure 2. Causal pathway linking private prayer to mental health among select Filipino Christian youth.

4.3. Intimate Relationship between Prayer and Mental Health

Through contemporary culture, people develop practices and resources for everyday life in a given society (). In the Philippines, the gospel took root in the people’s hearts and shaped an unmistakable Filipino and Christian identity (). There are several reasons why Christianity became embedded in Filipino culture and led to the widespread acceptance of this religion among native Filipinos, including the fundamental congruence between the autochthonous and Catholic religions (). In light of this study, the researchers argue that the flourishing of Christianity in contemporary Philippine society can also be attributed to the positive effects of the Christian faith on the mental health and well-being of many Filipinos.
This study reveals five important insights regarding the intimate relationship between prayer and mental health among select Filipino Christian youth. Firstly, prayer is a way to communicate directly with God during difficult times. According to (), prayers to God can change things. When people believe in and communicate with God, the individual feels a great sense of internal control of the external agents, especially in times of crisis. Communicating with God helps individuals overcome problems because they believe God is in control. Secondly, they pray before making important life decisions and choices. () pointed out that young people seek the guidance of God through prayer, especially during uncertain times. Praying to God can give a subjective sense of control over events, and can positively influence the situation. Hence, prayer is important for individuals (). Thirdly, prayer allows them to express gratitude to God, examine themselves (self-reflection), and persevere, despite their sufferings. Studies show gratitude confers positive benefits, including interpersonal, emotional, and physical flourishing (; ). Through prayer, the select Filipino youth feel grateful for the blessings they receive and experience positivity in life. Fourthly, prayer evokes positive emotions, such as relief and joy, in times of distress. It has been shown that the experience of prayer can help neutralize negative emotions and boost positive emotions. This can serve as a life-enhancing factor for the individual to cope with stressful situations (). Lastly, prayer gives them a sense of security from God. In the study of (), the participants claim that they experience support and guidance through prayer. They believe that God is in control, and they are secure and protected amidst uncertainties. () assert that “culture affects perception and cognition at both the social and individual levels” (p. 6). As such, the researchers argue that private prayer, an important marker of Christian identity, contributes positively to mental health among religiously involved Filipino Christian youth.

4.4. The Source of Beliefs

Many of the powerful cognitions of the select Filipino Christian youth on prayer are anchored in Christian scriptures, teachings, and tradition. Jesus communicated with God during his tribulations. He prayed, “My Father, if it is possible, let this cup pass from me; yet not as I will but what you will” (, Matthew 26:39). When Jesus was at death’s door, he cried, “My God, my God, why have you forsaken me?” (, Matthew 27:46). Also, in seeking wisdom to make the right decisions, the Psalmist prays:
“Answer me quickly, O Lord; my spirit fails.
Do not hide your face from me, or I be like those who go down to the pit.
Let the morning bring me word of your unfailing love, for in you I put my trust.”
()
Moreover, Paul teaches, “The Lord is near. Do not be anxious about anything, but in situation, by prayer and petition with thanksgiving, present your requests to God” (). In addition, human emotions during prayers are also highlighted in Christian scriptures. The Psalmist implores God:
“Turn to me and be gracious, for I am lonely and afflicted.
Relieve the troubles of my heart, and bring me out of my distress.
Consider my affliction and my trouble, and forgive all my sins”.
()
God also promises his people protection. In the Second Book of Samuel, God is described as:
“my rock in whom I take refuge, my shield and the horn of my salvation,
my stronghold and my refuge […]”.
()

4.5. The Value of Prayer

The Catholic Church teaches the immense value of prayer. According to (), “Life is filled with difficulties and trials. Christians, however, should not give up since they possess the power of the Holy Spirit to overcome such challenges. The peace from encountering Jesus daily in prayer lasts even during trials and sufferings” (para. 2). Also, prayer is essential to discernment, and should be considered in making significant life decisions (). Moreover, praying for forgiveness leads to conversion, and closes the gap between humans, their neighbors, and God.
According to Christian teachings, sin is a failure in genuine love for God and neighbors, caused by a perverse attachment to certain goods (). As Christians acknowledge their sins, they strive towards interior repentance, which involves conversion to God and turning away from evil (). The decision to show genuine love to one’s neighbors (i.e., other people) is central to cultivating harmonious social relationships. Further, prayer strengthens the spirit of many people struggling with life’s challenges. () says, “God strengthens us through prayer, so problems do not steal our joy. Our daily prayers can make us more courageous, freer, and even happier” (para. 4).

4.6. The Experience of Prayer Leading to Positive Emotional Health

This study shows that select Filipino Christian youths pray when they feel down or troubled. Through prayer, their decisions and choices are guided by their communication with God. They seek God’s guidance in navigating life’s often turbulent waters. As praying about a problem frees up cognitive resources that would otherwise be consumed by worrying and ruminating (), the researchers speculate that the informants can come up with better options and make better decisions when they pray. Furthermore, prayer allows them to reinterpret their cognitions, which is essential because, as () puts it, “individuals’ interactions with God through prayer help make situations less threatening” (p. 417). The respondents also mentioned that prayer evokes human virtues in them. They show gratitude to God for the blessings they receive every day. Prayer also cultivates their patience and honesty. For many respondents, prayer is critical to their cognitive appraisal of stressful events, and serves as a coping resource. To maintain mental peace and tranquility, they speak with God privately. The protection and availability of God help Filipino Christian youth cope effectively with stressors. As a result, events are no longer perceived as uncontrollable or only controllable by others, but rather as something able to be overcome by divine intervention ().

5. Limitations and Strengths

In this empirical study, we examined what constitutes prayer from the perspective of Filipino Christian youth, and examined how prayer facilitates their emotional and mental health. It is, however, difficult to generalize the findings to Filipino youth as a whole because of the small number of respondents and the qualitative nature of the study. Using a larger sample of participants, other researchers can study how prayer supports the mental and physical health of people dealing with significant life stressors.
It is also pertinent to note that the research focused only on one dimension of religiosity and its impact on one mental health component among youth. In the Filipino context, current research shows that many Filipino Christian youths also demonstrate religious commitment through ideology (). Researchers may examine how Filipino Christian youths’ strong belief in transcendent reality and private prayer influences their decision-making, health behaviors, and health maintenance.
This paper also explored a potential causal pathway connecting prayer to mental health among Filipino youth. While the model attempts to explain the link between prayer and mental health, further research is needed to validate it. The researchers hope that other scholars will investigate further the nexus between R/S, mental health, and physical health among youth.

6. Conclusions

As a result of our study of the notions, motivations, and emotions of select Filipino Christian youth regarding prayer, we can conclude that prayer is crucial to contemporary, religiously involved youth. Their communication with God is a resource for religious coping. When they feel down or troubled, their firm belief in God’s help and protection brings calm, relief, and joy, which helps improve their emotional well-being. In addition, their practice of spontaneous talking and listening to God in silence, especially during distress, facilitates a positive appraisal of a negative situation.
A person’s emotional health is an integral part of their mental health. In light of this, this study argues that the private prayers of select Filipino Christian youth are vital to their mental health. The paper also suggests that countries struggling to provide comprehensive mental health services for their people consider R/S as a means to promote, protect, and care for mental well-being.

Author Contributions

Conceptualization, F.A.D.C. and C.D.B.D.C.; methodology, F.A.D.C., software, F.A.D.C.; validation, F.A.D.C., C.D.B.D.C. and H.G.K.; formal analysis, F.A.D.C.; investigation, F.A.D.C., C.D.B.D.C. and H.G.K.; resources, F.A.D.C., C.D.B.D.C. and H.G.K.; data curation, F.A.D.C.; writing—original draft preparation, F.A.D.C. and C.D.B.D.C.; writing—review and editing, F.A.D.C., C.D.B.D.C. and H.G.K.; visualization, F.A.D.C., C.D.B.D.C. and H.G.K.; supervision, F.A.D.C. and H.G.K.; project administration, F.A.D.C. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted per the guidelines of the Declaration of Helsinki. Data were collected within an accepted educational setting. More importantly, the information obtained is encoded in such a manner that the identity of the human subjects cannot readily be ascertained, directly or through identifiers linked to the subjects.

Data Availability Statement

Data for the current study is available upon written request to the corresponding author.

Acknowledgments

Thank you to the Center for Spirituality, Theology and Health of Duke University, NC, USA, John Templeton Foundation, De La Salle University and MDPI Religions.

Conflicts of Interest

The authors declare no conflict of interest.

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