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Journal of American College Health
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Conceptualization and Measurement of the Spiritual
and Psychological Dimensions of Wellness in a College
Population
Troy B. Adams PhD , Janet R. Bezner PT, PhD , Mary E. Drabbs EdD , Robert J. Zambarano PhD &
Mary A. Steinhardt EdD
Published online: 24 Mar 2010.
To cite this article: Troy B. Adams PhD , Janet R. Bezner PT, PhD , Mary E. Drabbs EdD , Robert J. Zambarano PhD & Mary A.
Steinhardt EdD (2000) Conceptualization and Measurement of the Spiritual and Psychological Dimensions of Wellness in a College
Population, Journal of American College Health, 48:4, 165-173, DOI: 10.1080/07448480009595692
To link to this article: http://dx.doi.org/10.1080/07448480009595692
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Conceptualization and Measurement of the
Spiritual and Psychological Dimensions of
Wellness in a College Population
Downloaded by [University of Texas Libraries] at 12:56 06 July 2013
Troy B. Adams, PhD; Janet R. Bezner, PT, PhD;
Mary E. Drabbs, EdD; Robert J. Zambarano, PhD;
Mary A. Steinhardt, EdD
Abstract. Wellness is commonly conceptualized as having many
dimensions, but little effort has been made to evaluate how spiritual and psychological dimensions are related to overall wellness.
To explore the relationship between measures of spiritual and psychological wellness and perceived wellness in a college student
population, the authors administered a series of survey instruments
to 1 12 undergraduate students under quiet classroom conditions.
They used the Life Attitude Profile to measure spiritual wellness,
the Life Orientation Test and the Sense of Coherence Scale to
measure psychological wellness, and the Perceived Wellness Survey to measure overall wellness. Path analysis performed with a
proposed theoretical model revealed that the effect of life purpose
on perceived wellness was mediated by optimism and sense of
coherence, which had independent effects on perceived wellness
beyond that of life purpose. The findings suggested that an optimistic outlook and sense of coherence must be present for life purpose to enhance a sense of overall well-being.
Key Words: psychological health, spiritual health, wellness
0
’
ne of the primary goals of Healthy People 2010‘ is
to increase quality and years of life for all Americans. Improving the quality
.
. of student life has long
been a concern for university educators, administrators, and
professional staff, who have placed particular emphasis on
students’ health-related quality of life because college students typically experience developmental and behavioralassociated threats to health that are unique to this phase in
their lives2
In a 1997 article in the Journal of American College
Health, Grace2 suggested that campus health providers
focus their efforts beyond individual behaviors. Health
improvement efforts, he wrote, would be enhanced by
building campus “wellness communities.” The thrust of his
suggestion was that college health personnel would be well
advised to emphasize wellness culture rather than disease
avoidance in campus programs.
A wellness approach may seem more palatable on an
intuitive level, but much remains to be learned about wellness. In particular, little is known about some of the less
studied dimensions of wellness, such as the spiritual and
psychological aspects of health.
Since Halbert Dunn3 formally defined wellness in 1961,
many others have conceptualized and illustrated this concept.”’” Unfortunately, these conceptual foundations and
models have not been used to shape research questions or
influence program development, nor have they been empirically evaluated. Certainly, validation of wellness conceptual models should be an important prelude to integrating
wellness principles into practice. Therefore, both the presentation and validation of a model of wellness has been
needed. The model we present in this article includes both
spiritual and psychological dimensions and was tested on a
college population.
Wellness Model and Measure
Troy B. Adams is an associate professor in the School of
Applied Health and Educational Psychology at Oklahoma State
University, Stillwater; Janet R. Bezner is an assistant professor in
the Department of Physical Therapy, Southwest Texas State
University, San Marcos; Mary E. Drabbs is an assistant professor
in the Department of Health, Physical Education, and Recreation
at Eastern New Mexico University, L a s Cruces; Robert J.
Zambarano is manager of statistical services, Pharmac, Inc,
Austin, Texas, and Mary A . Steinhardt is an associate professor in
the Department of Kinesiology and Health Education at the
University of Texas, Austin.
VOL 48, JANUARY 2000
The model and corresponding measure we present are
based on perceptions of wellness. Because most wellness
measures address clinical, physiological, or behavioral
manifestations of disease or risk factors for disease, the Perceived Wellness Survey (PWS) is unique. The focus on perceptions is important for several reasons. First, very strong
and consistent data indicate that subjective perceptions are
valid indicators of future objective health, even after statistically controlling for confounding variables.’ ‘-I5 Second,
165
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COLLEGE HEALTH
perceptions serve as a filter through which information or
stimuli must pass before they are interpreted.16This principle is the basis of cognitive restructuring. That perceptions
precede physical responses and behaviors is supported by
the recognition that perceptions are at the core of several
health theories” and models.18-20Finally, various research
findings support the importance of perceptions. The social
support literature indicates that perceived support rather
than received support has the most powerful influence on
Furthermore, the stress literature suggests that
perceptions of internal resources enable individuals to survive and thrive under conditions of extreme tress.^^.^^
In addition to being perceptually focused, the model and
corresponding measure are founded on three principles
common to all conceptualizations of wellness: (a) multidimensionality, (b) balance among dimensions, and (c) salutogenesis (defined as causing health rather than illn e ~ s) . ~
First, the model and measure include the physical, social,
emotional, intellectual, spiritual, and psychological dimensions of wellness. Second, the model is dynamically bidirectional, which incorporates balance among dimensions
(see Figure 1).
The top of the model represents wellness because it is
expanded to the fullest possible extent, whereas the tightly
constricted bottom represents illness. Illness in this model is
not as much a state of physiological disease as it is a perception of disconnection, poor self-esteem, poor physical
health, pessimism, existential frustration, lack of intellectual stimulation, or any combination of the above. Any of
these conditions could lead to physical disease. Between the
wellness and illness poles of the model are innumerable
fluctuations in each of the dimensions, with various states
of balance among them. Thus, “dynamically bidirectional”
suggests movement in the vertical plane between the wellness and illness poles and a constant, balance-seeking fluctuation in a horizontal plane. Finally, the PWS is salutogenically rather than pathogenically focused.
In this model, the spiritual dimension is defined as a positive sense of meaning and purpose in life. The psychofogical dimension is defined as the perception that one will experience positive outcomes to the events and circumstances of
life. Because both of these dimensions are multifaceted, neither of the above definitions is intended to be comprehensive, but both are at the core of spiritual and psychological
dimensions.When the terms spirituality or spiritual wellness
are used, the above definitions are the intended interpretation, as they are for psychological wellness. For definitions
of the other dimensions in the model, see Table 1. The following discussion provides an overview of the theoretical
foundations of the spiritual and psychological dimensions.
Spiritual Wellness
Dunn stated that “we can no longer ignore the spirit . . .
as a factor in our medical and health disciplines . . . which
are designed as though the sum total of our concern is for
the body and the mind . . . leaving to metaphysics and religion the affairs of the ~ p i r i t . ” ~ ~ (InP ~this
’ ~ )regard, it is
166
FIGURE 1
The Wellness Model
(‘
I
Physical
S
p
i
r
i
t
Social
u
a
)
IPsychological
X
Note. The top of the model represents wellness because it is expanded to the fullest possible extent, whereas the tightly constricted bottom represents illness. In between are combinations of wellness in
several dimensions and the various states of balance among them. The
lines that extend from the inner to the outer circle indicate the possibility of bidirectional movement along each continuum. Movement in
every dimension influences and is influenced by movement in all
other dimensions. For example, in extreme wellness conditions, one
or more dimensions expand and place an “outward wellness force” on
each of the other dimensions. By contrast, in extreme illness conditions, one or more dimensions contract and cause either compensatory or concomitant change in each of the other dimensions.
important to note that spirituality and religion are related
but are not synonymous. Developing spirituality, as defined
above, can add meaning to the practice of religion, whereas
the practice of religion can deepen spirituality. Therefore it
is inappropriate to discount the spiritual importance of organized religion to millions of people, yet equally inappropriate to suggest that one must practice a specific religion if
one is to develop spirituality.26It is possible to promote and
measure the development of spiritual wellness while remaining sensitive to individual values and belief systems.
For example, Seawardz7presents an excellent simple model
for the integration of spiritual principles into a variety of
settings.
Many observers have suggested that the public interest in
spirituality is a symptom of increasing levels of isolation,
disconnection, and existential frustration in our
Interestingly, a noticeable emphasis on spirituality has been
evident in some of the best selling books of the 1 9 7 0 ~ , ~ ~
1980s3*and 1990s.33-35
In addition, medicine has begun to
recognize the influence of spirituality on i l l n e ~ s .Con~~,~~
currently, the absence of spiritual health initiatives has been
frequently noted in the l i t e r a t ~ r e . * ~
As> a~ result,
~ - ~ ~ spirituJOURNAL OF AMERICAN COLLEGE HEALTH
DIMENSIONS OF WELLNESS
~~
tion between optimism and quality of life in coronary artery
bypass surgery patients initially and at 6 months postsurgery.
The optimistic men in that study were more likely than those
who were less optimistic to exercise vigorously, return to
work, and resume their normal social and sexual activities.
Component
Definition
In examining the relation between dispositional optimism
and frequency of physical symptoms during the 4 weeks
Emotional centeredness A secure self-identity and a
before final examinations in a group of university students,
positive sense of self-regard
Scheier and CarverSYdemonstrated that students who were
Intellectual stimulation Perception of being internally
optimistic reported fewer physical symptoms than pesenergized by an optimal
simistic students during the study period. These researchers
amount of intellectually stimulating activity
concluded that dispositional optimism was a significant preA positive perception and
Physical resilience
dictor of reporting symptoms and, thus, of physical health.
expectation of physical health
O’Brien and colleaguess2also found that optimists reported
Psychological optimism Perception that one will experiless stress and fewer physical symptoms than nonoptimists
ence positive outcomes to the
did. Optimists were generally ill less often, made fewer visevents and circumstances of
life
its to the doctor, had better stress resistance and stronger
Perception of having support
Social connectedness
immune systems, and lived longer.s3However, we know of
available from family or
little
evidence linking indicators of optimism and perceived
friends . . . and perception
wellness.
of being a valued support
Sense of coherence is defined as “a global orientation that
provider
Spiritual life purpose
A positive sense of meaning
expresses the extent to which one has a pervasive, enduring
and purpose in life
though dynamic feeling of confidence that one’s internal and
external environments are predictable and that there is a high
probability that things will work out as well as can reasonably be expe~ ted. ”~ ~A( Pperson
’ ~ ) who possesses a strong
ality has been recognized as an important but insufficiently
sense of coherence would be described as resilient and optideveloped dimension of wellness.27-28~30*40.4’
mistic. Sense of coherence has been shown to have a strong
Over the past 2 decades, several theorists have included
connection with health. In predictive studies, the sense of
spirituality as a dimension of w e l l n e s ~ . ~ Although
~ ” ’ ~ ~ ~ ~ ~ coherence
~
construct significantly predicted psychological
conceptualizations of the spiritual dimension vary among
symptoms,” influence in the workplace, and perceptions of
theorists, some common threads exist. These include a sense
assistance available from others.61Correlational studies have
of meaning and purpose in life8v26,27.42,43,4s47;
connectedness
also reported that a sense of coherence is positively related
to self, the environment, or a higher p o ~ e 8 * ~ ~ . ~ ~ . to
~ hardiness,60
~ - ~ ~ - ~
~ . ~ ~ - ~ ~health
;
multidimensional
locus of control, and
and a belief in a unifying life f o r ~ e .These
~ , ~ ~common conindices of social support,62and is negatively associated with
ceptual threads serve as support for efforts to measure spiriperceived stress and depre~sion,6~@
and a tentual wellness and to enhance understanding of the relation
dency toward alcoholism.h6In a prospective study using an
between spiritual wellness and overall wellness. For this
elderly population, R.B. Flannery and G.J. F l a n n e ~ yfound
~~
study, we selected a measure of life purpose to represent the
that a strong sense of coherence was negatively associated
spiritual dimension of wellness, which is congruent with the
with life stress and psychological symptoms.
definition in the model of perceived wellness.
In this study, we evaluated the relationship of the spiritual and psychological dimensions to each other and to the
PsychologicalWellness
overall model of perceived wellness. First, we hypothesized
The core of the psychological dimension of wellness in
that a significant positive relationship would exist between
our model is optimism, defined as the perception that one
the perceived wellness (PW), the dependent variable, and
will experience positive outcomes to the events and circumthe determinants of life purpose (LP), optimism (0)and
stances of life. We selected measures of dispositional optisense of coherence (SC). Second, we hypothesized that the
mism and sense of coherence to represent the psychological
effect of LP on PW would be largely, if not completely, medimension of wellness.
diated by 0 and SC (see Figure 2) and would reflect the
Psychologists have produced much scientific evidence in
view that a sense of meaning and purpose in life becomes
the last decade that links dispositional optimism to good
more developed as the individual ages from late adoleshealth and pessimism to poor health.5’-57Carvers1and assocence to older adulthood,68and that character dispositions,
ciates studied the adjustment of 70 patients with early stage
such as optimism and resilience, are typically manifested
breast cancer and found that optimism was significantly
much earlier in life than life purpose.56
related to subjective well-being before surgery and at 3
Because the sample in this study consisted of undergradumonths, 6 months, and 12 months postsurgery. Similarly,
ate college students, we expected that the participants’ sense
ScheieP and associates reported a strong positive correlaof purpose in life would not be as acutely developed and that
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TABLE 1
Definitions of Components in the Perceived
Weliness Survey
VOL 48, JANUARY 2000
167
COLLEGE HEALTH
FIGURE 2
Path Diagram for the Proposed and Alternative Models in a Study of Spiritual
and Psychological Dimensions of Wellness
Proposed model
R2 = .41
.60
coherence
R2 = .36
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Alternative model
I
Optimism
k
.
3
0
R2 = .29
R’ = .42
wellness
Sense of
coherence
the effect of spiritual wellness on perceived wellness would
therefore be mediated by psychological wellness. We also
examined an alternative model-that the effect of psychological wellness on perceived wellness would be mediated by
spiritual wellness. In that model, the effect of optimism and
sense of control on perceived wellness would be largely, if
not completely, mediated by life purpose (see Figure 2).
METHOD
Sample
Participants ( N = 112) were a convenience sample of
undergraduate students enrolled in a health education class
at The University of Texas at Austin. Eighty-one percent
were women ( n = 91), 19% were men ( n = 21), and a majority (81%) were White. The participants ranged in age from
16 to 58 years (M = 23.2, SD = 5.4). In accordance with
Internal Review Board procedures of the sponsoring institution, we informed all of the participants about the confidential nature and purpose of the study. We also told them
that participation in the study would not influence their
class grades. Five of the students did not complete the survey; thus, the participation rate was 96%. Testing occurred
in a quiet classroom environment, and the students were
allowed 20 minutes to complete the survey, which included
four different scales. None of the students needed the full
amount of time.
Measures
Life Attitude Profile
We used the Life Purpose subscale from the Life Attitude
Profile69(designed to measure the multidimensional nature
168
of attitudes toward life). Life purpose (LP) is defined as a
measure of zest for life, fulfillment, contentment, and satisf a ~ t i o n . ~ The
~ . ~ ’subscale contains 9 items scored from 1
(strongly disagree) to 7 (strongly agree). Total scores range
from 9 to 63, with higher scores indicating a greater life
purpose. Sample items include “Basically, I am living the
kind of life I want to live,” and “I have discovered a satisfying life purpose.” In the initial psychometric study of the
Life Attitude Profile, the internal consistency for the L P
subscale was alpha = .83,6ywhich compares favorably to the
internal consistency found in the current study (a = 3 7 ) .
Life OrientationTest
This scale possesses 8 items (plus 4 filler items) designed
to measure dispositional optimism. Scheier and Carver
defined optimists as individuals who “generally believe that
good rather than bad things will happen to them.”5y(p219)
We
used 8 of the original 12 items in the study, omitting the 4
filler items designed to disguise the content of the scale
because of space limitations. This may have inflated internal consistency values, although such inflation is unlikely
because the 8 items were integrated with other psychometric scales that would have had a similar masking effect.
Responses range from 0 (strongly disagree) to 4 (strongly agree). Total scores range from 0 to 32, with higher
scores indicating greater optimism. Sample items include
“In uncertain times, I usually expect the best,” and “If
something can go wrong for me, it will.” The Life Orientation Test has been shown to possess adequate internal consistency (a = .76) and has a test-retest reliability coefficient
of .79.59Internal consistency of the test for the current study
was alpha = 2 2 .
JOURNAL OF AMERICAN COLLEGE HEALTH
DIMENSIONS OF WELLNESS
Sense of Coherence Scale
In our study, we used the 13-item short version of the
SC scale. Each item is scored on a 7-point differential
scale, with variable response
Scores range
from 13 to 9 1, and higher scores indicate a greater sense of
coherence. Among the items included are “Do you have
the feeling that you don’t really care about what goes on
around you?’ “Has it happened in the past that you were
surprised by the behavior of people whom you thought you
knew well?’ and “How often do you have the feeling that
there’s little meaning in the things you do in your daily
life?” The SC has been shown to have high reliability (a =
.84-.93)23,63and construct validity estimates ( r =
.27-.50).7’The internal consistency of SC for the current
study was alpha = .85.
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Perceived Wellness Survey
The PWS, which has been described in greater detail
elsewhere: was developed to fill a void in wellness measurement. Clearly, the conceptual notion of wellness as defined by Dunn3and others5-I0has not been adequately measured (nor will it ever be) by commonly used body-centered
evaluation techniques. Although these techniques are
important, such objective measures of health will probably
reveal little about spiritual or psychological wellness. Yet
understanding how both are related to overall wellness
would be important for counselors and health-enhancement
professionals alike. Thus, we selected perceived wellness,
rather than commonly used types of wellness indicators, as
the dependent variable in this study.
We defined perceived wellness as the sense that one is
living in a manner that permits the experience of consistent,
balanced growth in the emotional, intellectual, physical,
psychological, social, and spiritual dimensions of human
exi~tence.~
Sample items from each dimension are, respectively, “In general, I feel confident about my abilities,” “In
the past, I have generally found intellectual challenges to be
vital to my overall well-being,” “I expect to always be physically healthy,” “In the past, I have expected the best,” “My
friends will be there for me when I need help,” and “I
believe there is a real purpose for my life.” Each dimension
is represented by 6 items ranging from 1 (very strongly disagree) to 6 (very strongly agree).
The dimensional scores are integrated into a wellness
composite score by combining the magnitude or mean of
each dimension with the balance or standard deviation
among dimensions. Scores range from 3 to 29, with higher
scores indicating greater wellness. The PWS has been shown
to possess excellent estimates of factorial and construct
validity, as well as internal consistency reliability (a= .91).4
Internal consistency in this sample was alpha = .91.
to examine the proposed and alternative models of the relationship between perceived wellness and the set of determinants, including life purpose, optimism, and sense of coherence (see Figure 2). In this article, we report implied
correlations for each model and comparisons with the
“original” (ie, Pearson product-moment) correlations.
To examine goodness-of-fit indices (GOF) of the two
models, we used the chi-square test, the normed-fit index
(NFI), the comparative-fit index (CFI), and the TuckerLewis index (TLI). The chi-square statistic provided a test
of the null hypothesis that the reproduced covariance matrix
had the specified model structure (ie, that the model fit the
data). The NFI ranges from 0 to 1, where 0 represents the
GOF associated with a null model (one specifying that all
the variables are uncorrelated) and 1 represents the GOF
associated with a “saturated” model (one with 0 degrees of
freedom that perfectly reproduces the original covariance
matrix). The CFI and TLI are similar to the NFI. Values
greater than .95 on the NFI, CFI, and TLI indicate a good fit
between model and data.72
RESULTS
Mean scores and standard deviations for all variables are
shown in Table 2, and Pearson product-moment correlations among the variables are shown in Table 3. The first
hypothesis was supported because higher scores on perceived wellness were significantly related to higher scores
on life purpose, optimism, and sense of coherence.
Results of the path analysis for the second hypothesis
supported the proposed model, as presented in Figure 2.
Estimation of this model revealed a nonsignificant chisquare value, x2( 1 , N = 1 12) = 2.22,p = .136, indicating that
the model fit the data well. We report the implied correlations in Table 3 and suggest that the model-based covariances closely reproduce the actual data-based covariances,
lending further support to the claim that the model fit the
data well. All values of the descriptive GOF tests exceeded
.95, which shows a very good fit between the model and the
data (see Table 4).
Path coefficients for the proposed model appear in Table
5 . Estimation of the alternative model revealed a significant
chi-square value, ~ ~ ( N1 =, 112) = 35.21, p = .OOO,indicating that the model does not fit the data well. The proposed
model (see Figure 2) accounts for a much greater portion of
TABLE 2
Means and Standard Deviations for All Variables
in a Study of Spiritual and Psychological
Dimensions of Wellness
Variable
M
SD
47.8
23.9
8.12
4.5 1
62.4
16.5
10.89
Analysis
To test the first hypothesis, we calculated Pearson product-moment correlation coefficients between perceived
wellness and life purpose and optimism and sense of coherence. To test the second hypothesis, we used path analysis
VOL 48, JANUARY 2000
Life purpose
Optimism
Sense of coherence
Perceived wellness
3.14
~
169
COLLEGE HEALTH
3
Many spiritual teachers have emphasized the importance
of having a purpose in life. R i n p ~ c h esuggested
~~
that life
purpose results from undertaking a spiritual journey with all
the intelligence and courage for transformation we can
muster. This view is also reflected in the following quotation from Viktor Frankl:
Everyone has his own specific vocation or mission in life to
carry out a concrete assignment which demands fulfillment.
Therein he cannot be replaced, nor can his life be repeated.
Thus, everyone's task is as unique as is his specific opportunity to implement it.74(p'13)
TABLE 3
Pearson Product-Moment Correlation
Coeff iclents Among Variables
Variable
2
1
Pearson product-moment correlations
1 Life purpose
2 Optimism
3 Sense of coherence
4 Perceived wellness
.55
-
.60
.59
-
.53
.55
.66
Implied correlations for proposed model
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1 Life purpose
2 Optimism
.55
3 Sense of coherence
4 Perceived wellness
.60
.45
.58
.55
-
.66
Implied correlations for alternative model
1 Life purpose
2 Optimism
3 Sense of coherence
4 Perceived wellness
.55
-
.60
.58
-
.53
.30
.32
Note. All correlations were significant, p < .05.
TABLE 4
Goodness-of-Fit Indices for the Proposed and
Alternative Models
Model
Proposed
Alternative
x2
2.22
35.2
DF
p
NFI
CFl
TLI
1
2
,136
.OOO
,999
.979
,999
.980
.993
,990
II
Note. NFI = normed-fit index; CFI = comparative-fit index; and
TLI = Tucker-Lewis index.
I
variance in perceived wellness (Rz = .48) than the alternative model (R2 = .29). Even though the alternative model
was not supported, we nevertheless report the implied correlations (Table 3) values for the descriptive GOF tests
(Table 4) and path coefficients (Table 5).
COMMENT
In summary, life purpose, optimism, and sense of coherence were related to perceived wellness. However, the effect
of life purpose on perceived wellness was mediated by optimism and sense of coherence, which had independent
effects on life purpose. Overall, the results support the proposed model and not the alternative model. In addition, the
results add further insight into the relationship between the
spiritual and psychological dimensions of wellness in the
college student population.
170
Discovering, then honoring one's unique purpose in life
is difficult, given that we live in a culture preoccupied with
the notion that success and power will produce happiness
and well-being. Paradoxically, according to some theorists,
the pursuit of success and power typically results in hollow
satisfaction and, in the long term, produces feelings of
bewilderment, anger, and c o n f ~ s i o n .If~ ~
these
. ~ ~presumptions are true, to exist in this type of environment and maintain a sense of meaning and purpose in life would require
strong internal resources. Optimism and a sense of coherence are perhaps types of internal resources that enable people to fulfill their own true nature or life purpose. Thus, it
was not surprising that the effects of life purpose on perceived wellness in our study were mediated by psychological constructs, such as optimism and sense of coherence.
In the psychological dimension, both optimism and sense
of coherence have been positively associated with
health.23.53-57*70
We found that optimism and sense of coherence were significant predictors of perceived wellness.
Interestingly, a common characteristic of individuals with
high levels of optimism and a strong sense of coherence is
an enduring sense of personal ~ o n t r o l . Such
~ ~ . ~individuals
~
are confident that they have the resources and abilities to
meet the demands arising from both their internal and external environments and recognize that the demands of life are
challenging and worthy of personal investment. The link
between personal control and health also has been supported in several studies using various designs.
For example, Visintainer and colleagues76 investigated
the phenomenon of personal control and helplessness in a
laboratory setting with three groups of rats that had been
implanted with sarcoma cells. The researchers gave the first
group a mild escapable shock, the second group a mild
inescapable shock, and the third group no shock at all.
Within a month, 50% of the rats that received no shock died
and 50% rejected the tumor, which was considered normal.
However, 70% of the rats who were able to escape the
shock because of their own efforts rejected the tumor,
whereas only 27% of the rats with no control over the shock
rejected the tumor.
Visintainer and colleagues' results were supported in a
set of classic human studies that demonstrated that elderly
people living in a nursing home who were given more
choice and responsibility for their lives were happier77and
lived longer than those given few choices7*Seligman, who
discussed the previous three studies in his work, suggested
JOURNAL OF AMERICAN COLLEGE HEALTH
DIMENSIONS OF WELLNESS
TABLE 5
Path Coefficients for the Proposed and Alternative Models
in a Study of Spiritual and Psychological Dimensions of Wellness
Predicted
variable
Predicting
variable
Unstandardized
estimate
Standardized
estimate
SE
CR
.60
.3 1
.I 1
.40
.25
.52
.04
.02
1.89
3.39
4.33
2.91
5.96
~
Proposed model
sc
0
0
PW
PW
LP
LP
sc
0
sc
.83
.11
.I6
.I8
.14
.05
.06
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Alternative model
0
sc
.24
.59
.03
1.61
LP
LP
0
sc
PW
LP
.55
.3 1
.21
.30
.42
.54
.I6
.Ol
.03
3.38
4.70
6.49
Note. SC = sense of coherence, LP = life purpose, 0 = optimism, PW = perceived wellness. All path
coefficients exceeded the absolute critical ratio (unstandardized estimate/standarderror) value of 2.0 and
are therefore significant beyond p < .05.
that these findings illustrate that “choice and control could
save lives and, perhaps, that helplessness could ki11.”56(p’69)
These classic studies illustrate the link between psychological health and overall well-being. Our current study provides additional support for the importance of optimism and
a sense of coherence as components of psychological wellness. With respect to the relationship between the psychological variables, a greater sense of coherence or resilience
leads to a more optimistic outlook on life.
In light of these findings, four possible limitations of this
study warrant consideration. First, it is important to acknowledge the difficulty in trying to quantify spiritual and
psychological wellness because these constructs are subjective. However, attempting to quantify these constructs is an
important prelude to understanding them better.79
Second, the use of a convenience sample that was largely made up of female students limits the generalizability of
our findings. To assess the impact of potentially confounding variables that we measured but did not report here, we
performed t tests and found no gender differences in measures of free-floating anxiety, global self-concept. or physical self-esteem. The relationship of these and other variables to perceived wellness is more completely described
elsewhere.80 Certainly, further research with larger and
more demographically diverse populations would strengthen the findings of this study.
Third, because this study is one of the first data-based
attempts to investigate spirituality in the college student
population, the results are clearly preliminary. Much more
remains to be done. Further work using path analysis and
structural equation modeling to examine various conceptual models is needed. Finally, the design of our study is
cross-sectional, thereby limiting the conclusions that can be
VOL 48, JANUARY 2000
drawn. Using a longitudinal design in future investigations
would enable researchers to examine the effects of targeted
interventions on spiritual and psychological wellness and,
subsequently, on perceived wellness.
Despite these limitations, several important implications
are noteworthy. Optimism and sense of coherence directly
affect overall wellness. The cultivation of a meaningful
purpose in life is a worthy goal that may enhance overall
wellness. On the basis of our findings in this study, however, we believe that an optimistic outlook and strong sense
of coherence are essential for a meaningful life purpose to
enhance overall wellness. We therefore recommend that
health professionals who develop and deliver spiritual
wellness programs to college students also focus on mobilizing internal resources, such as optimism and a sense of
coherence.
NOTE
Please address requests for further information to Troy B.
Adams, PhD, Oklahoma State University, 431 Willard Hall, Stillwater, OK 74078-0616.
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DIRECTOR
UNIVERSITY OF FLORIDA
STUDENT HEALTH C A R E CENTER
The University of Florida seeks full-time, non-tenure track Clinical
Assistant/Associat&ofessor and Director in the College of Medicine Department of
Community Health and Family Medicine to serve as chief executive for University’s
Student Health Care Center (SHCC). Position directs stalf of 200+employees in the
delivery of ambulatory health a r e including mental health services and health promotiodwellness activities to 42,500 University students. Position oversees
Occupational Health Program for 17,000 University employees that includes
Worker’s Compensation and pre-placement and periodic health monitoring programs. Responsibilities include 70%Administration, 20% Clinical Services and 10%
Education and Research. SHCC is fully accredited by the MAHC. Ancillary services
include on-site pharmacy, lab and X-ray. Position oversees $10 million dollar budget. Medical degree, BCBE in relevant specialty and Florida medical licensure or
eligibility are required. Health senices administration andlor adolexent/coUege
health experience strongly desired. Closing date for receiving applications is
January 31,2000. Anticipated start date is July I, 2OOO. Salary commensurate with
experiencdqualications. Send CV and three letters of recommendation to Ann M.
Grooms, M.D., Search Committee Chairperson, University of Florida Student Health
Care Center, PO.Box 117500, Cainesville, Florida 32611-7500. The University of
Florida is an Equal Employment Opportunity/Af6rmative Action Employer.
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VOL 48, JANUARY 2000
173