Development and Evaluation of the Religious and Spiritual Struggles Scale-5 (RSS-5)

Abstract

The purpose of this study was to develop a five-item form of the Religious and Spiritual Struggles Scale (RSS; Exline et al., Psychology of Religion and Spirituality, 6, 208-222, 2014), (2022). Drawing upon three samples – 711 depressed adults from prior studies that utilized the RSS (Study 1), 303 undergraduates from a public university in the Southeastern U.S. (Study 2), and 121 adults seeking psychotherapy and/or primary care in an integrated behavioral health clinic (Study 3) – findings indicated the five-item version represents a structurally sound and reliable instrument for assessing clinically relevant struggles (divine, interpersonal, moral, doubt, ultimate meaning struggles) in mental health care settings. Specifically, Cronbach’s alphas for the RSS-5 ranged from .77 to .85 across the three studies. Further, scores on this short form overlapped highly with the original RSS in Study 1 and were moderately to strongly associated with validated assessments of positive (well-being, flourishing, and perceived meaning in life) and negative (suicide ideation, depression and anxiety symptoms) mental health in Study 2 and 3. When accounting for depression and anxiety symptoms, RSS-5 scores were also uniquely associated with patients’ suicidal ideation over the past month in Study 3. Although we found evidence of multidimensionality of the selected items that aligned with psychometric findings for the original RSS (Exline et al., Psychology of Religion and Spirituality, 6, 208-222, 2014), findings also supported a unidimensional factor structure for the RSS-5 in each sample. Looking ahead, the RSS-5 will hopefully support clinical research and practice in ways that enhance training clinicians’ responsiveness to patients who are experiencing spiritual struggles.

Full text

Vol.:(0123456789)
Journal of Psychopathology and Behavioral Assessment (2025) 47:8
https://doi.org/10.1007/s10862-024-10182-9
Development andEvaluation oftheReligious andSpiritual Struggles
Scale‑5 (RSS‑5)
SarahG.Salcone1 · JosephM.Currier1· RyonC.McDermott1· DonE.Davis2· AmandaM.Raines3· YejinLee2·
JulieJ.Exline4· KennethI.Pargament5
Accepted: 4 November 2024 / Published online: 6 January 2025
© The Author(s) 2025
Abstract
The purpose of this study was to develop a five-item form of the Religious and Spiritual Struggles Scale (RSS; Exline etal.,
Psychology of Religion and Spirituality, 6, 208-222, 2014), (2022). Drawing upon three samples – 711 depressed adults from
prior studies that utilized the RSS (Study 1), 303 undergraduates from a public university in the Southeastern U.S. (Study
2), and 121 adults seeking psychotherapy and/or primary care in an integrated behavioral health clinic (Study 3) – findings
indicated the five-item version represents a structurally sound and reliable instrument for assessing clinically relevant strug-
gles (divine, interpersonal, moral, doubt, ultimate meaning struggles) in mental health care settings. Specifically, Cronbach’s
alphas for the RSS-5 ranged from .77 to .85 across the three studies. Further, scores on this short form overlapped highly with
the original RSS in Study 1 and were moderately to strongly associated with validated assessments of positive (well-being,
flourishing, and perceived meaning in life) and negative (suicide ideation, depression and anxiety symptoms) mental health
in Study 2 and 3. When accounting for depression and anxiety symptoms, RSS-5 scores were also uniquely associated with
patients’ suicidal ideation over the past month in Study 3. Although we found evidence of multidimensionality of the selected
items that aligned with psychometric findings for the original RSS (Exline etal., Psychology of Religion and Spirituality,
6, 208-222, 2014), findings also supported a unidimensional factor structure for the RSS-5 in each sample. Looking ahead,
the RSS-5 will hopefully support clinical research and practice in ways that enhance training clinicians’ responsiveness to
patients who are experiencing spiritual struggles.
Keywords Spirituality· Religion· Spiritual Struggle· Religious and Spiritual Struggles Scale· Mental Health
Spirituality1 and religion (S/R) are important aspects of
life for many people around the world. Globally, approxi-
mately 84% of the population identifies as religious (Pew
Research Center, 2017). Notwithstanding decreasing affili-
ations with many organized religions in the U.S., 73% of
Americans still endorse religion as important in their lives,
87% of the population believe in God or a Higher Power,
and 58% engage in prayer frequently (Gallup, 2020; Pew
Research Center, 2015). A robust empirical literature has
revealed diverse ways in which S/R may strengthen well-
being, reduce risk for mental and physical health conditions,
* Sarah G. Salcone
sgs2023@jagmail.southalabama.edu
1 Psychology Department, University ofSouth Alabama,
UCOM 1540, Mobile, AL36688, USA
2 Counseling Department, Georgia State University, Atlanta,
GA, USA
3 Southeast Louisiana Veterans Health Care System,
NewOrleans, LA, USA
4 Psychology Department, Case Western University,
Cleveland, OH, USA
5 Psychology Department, Bowling Green State University,
BowlingGreen, OH, USA
1 There are many definitions of religion and spirituality in mental
health professions. Drawing upon Pargament’s (2007) seminal work,
Davis et al. (2023) defined spirituality as “search for meaning and
connection with whatever they perceive as sacred, typically including
supernatural entities (e.g., deity/deities, saints, ancestors, karma, or
fate/destiny) or aspects of life viewed as a manifestation of the divine
(e.g., close human relationships) or as having transcendent or divine-
like qualities (e.g., nature or the universe)” (p. 510). Relatedly, reli-
gion refers to “search for sacred meaning (sense of transcendent sig-
nificance, purpose, and coherence) and connection in the context of
culturally sanctioned codifications (e.g., beliefs, values, and morals),
rituals (e.g., prayer, meditation, collective worship), and institutions
(e.g., families, faith communities, organizations)” (p. 511). We will
use “S/R” in the paper unless there is a reason to refer to one term or
the other specifically.
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Journal of Psychopathology and Behavioral Assessment (2025) 47:88 Page 2 of 15
and support healing and recovery when such issues occur
(for a review, see Koenig etal., 2023). Specifically, S/R can
support formation of beliefs, practices, and relationships that
promote adaptive coping and meaning making (Pargament
etal., 2013; Park, 2013), belonging and social connections
(VanderWeele, 2017a), attachment security with God or a
Higher Power (Davis etal., 2021), and healthy brain devel-
opment among high-risk groups (e.g., thickening of cortical
regions; Miller etal., 2014). However, a growing number
of scientific studies also indicate persons with depressive
disorders and other health-related conditions may struggle
with their S/R in ways that hinder recovery and possible
responsiveness to mental health treatment (Bockrath etal.,
2022; Currier etal., 2024; Pargament & Exline, 2022). As
such, the purpose of this study was to develop and evaluate
a five-item version of Exline etal.’s (2014) Religious and
Spiritual Struggles Scale (RSS) that could support clinical
research and practice for spiritual struggles.
Dening Spiritual Struggles
Pargament and Exline (2022) define spiritual struggles as
“experiences of tension, conflict, or strain that center on
whatever people view as sacred.” Whether in the form of
painful emotions (e.g., guilt, anger) or enduring internal con-
flict, Exline (2013) stated spiritual struggle “implies that
something in a person’s current belief, practice, or expe-
rience is causing or perpetuating distress” (p. 459). These
struggles usually fall into three categories: supernatural,
interpersonal, or intra-personal. Particularly for persons
whose meaning frameworks have been strongly shaped by
a theistic religious tradition, spiritual struggles might entail
feeling angry, neglected, or abandoned by God. Others may
struggle in relationships with fellow religious adherents and/
or leaders within their own tradition or another tradition.
Lastly, intra-personal struggles may emerge from doubting
core doctrines or teachings from one’s S/R, not living con-
gruently with perceived moral standards, or a painful void of
ultimate meaning about the deeper purpose of life in general
and/or the significance of one’s life in particular.Spiritual
struggles have been documented among persons with vary-
ing intersectional identities and realities with respect to age
(Krause etal., 2017), gender (Exline etal., 2021; Martoyo
etal., 2019), race and ethnicity (Krause etal., 2018), and
S/R background (including secular or atheist; Abu-Raiya
etal., 2015, 2016; Mercadante, 2020).
Research has also found that spiritual struggles are
particularly relevant for mental health care (Pargament &
Exline, 2022). Just as depression and other health-related
conditions might impair functioning in relational and voca-
tional domains, 50–90% of persons seeking mental health
care are somehow struggling with their S/R (Damen etal.,
2021; Currier etal., 2019a; Leavitt-Alcántara etal., 2023;
Rosmarin etal., 2014). Meta-analytic evidence from 32
longitudinal studies revealed spiritual struggles were pro-
spectively linked with severity of mental health challenges
over time (Bockrath etal., 2022). Focusing on 1,227 adults
engaging in spiritually integrated psychotherapies, Cur-
rier etal. (2024) similarly found those who were strug-
gling with their S/R were generally more psychologically
distressed throughout treatment, experienced reduction of
depression and other symptoms as concomitant spiritual
distress was reduced, and needed longer to achieve clinical
improvement. Of the studies that directly tested temporal
associations between spiritual struggles and mental health
symptoms in clinical samples, findings supported a Primary
Struggles Model in which the severity of spiritual struggles
was predictive of worse outcomes over time, or a Complex
Struggles Model in which reciprocal associations between
spiritual struggles and mental health outcomes occur over
time (Cowden etal., 2021; Currier etal., 2015; Pargament
& Lomax, 2013). Overall, these results indicate contending
with spiritual struggles can add a distinct burden for per-
sons seeking mental health care in ways that warrant routine
assessment and possible attention in treatment.
Measuring Spiritual Struggles
Exline etal.’s (2014) Religious and Spiritual Struggles Scale
(RSS) has emerged as a well-established and particularly
useful, reliable, and valid tool for assessing spiritual strug-
gles. When considering the spectrum of S/R diversity in the
U.S., the RSS has been used and adapted with a range of
groups including Christians (Exline etal., 2014), Muslims
(Abu-Raiya etal., 2015), Jews (Abu-Raiya etal., 2016), as
well as atheists and secular persons (Sedlar etal., 2018).
The measure has also consistently demonstrated concur-
rent and predictive validity through its associations with
symptoms of depression, anxiety, and other mental health
conditions (e.g., Bockrath etal., 2022; Cowden etal., 2021;
Currier etal., 2019a). Building on previous measures for
assessing generalized distress related to S/R (e.g., Exline
etal.’s (2000) Religious Comfort and Strain Scale, Parga-
ment etal.’s (2011) Brief RCOPE), the original 26-item RSS
captures six of the common ways in which people strug-
gle with S/R (i.e., Divine, Demonic, Interpersonal, Moral,
Ultimate Meaning, Doubting). A 14-item version has also
been evaluated by Exline etal. (2022). Factor analytic work
on the longer version supported a general spiritual struggle
factor as well as a micro-struggle approach in which the six
subscales can be used separately to assess distinct forms of
struggle (Exline etal., 2014; Stauner etal., 2016). Depend-
ing on one’s aims and objectives, researchers and clinicians
might utilize a total score on the RSS to gauge the overall
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Journal of Psychopathology and Behavioral Assessment (2025) 47:8 Page 3 of 15 8
severity of spiritual struggles or focus more squarely on spe-
cific forms of struggle in Exline etal.’s (2014) framework
with greatest relevance for their work.
Notwithstanding the psychometric strengths of exist-
ing versions of the RSS, a short form of this instrument is
needed to advance clinical research and practice for spir-
itual struggles. From a research standpoint, epidemiologic
studies and designs that repeatedly solicit responses over
time-limited periods (e.g., ecological momentary assess-
ment) necessitate concise measurement. Attrition is also less
likely to occur in longitudinal studies that focus on a range
of variables when follow-up assessments are not time-con-
suming and burdensome. Given the range of information that
clinicians need to gather in an initial assessment, a briefer
version of the RSS could also be included more easily in
an intake questionnaire or other routine procedures in their
settings. A short form of the RSS that captures the distinct
forms of struggle in Exline etal.’s (2014) framework might
also be used in routine outcome monitoring procedures to
holistically track patients’ progress in psychotherapy or other
clinical interventions. Further, Stauner etal. (2016) noted
items of the 26-item version of the RSS could be modeled
with a bifactor structure (Reise, 2012), such that the varying
types of struggle shared a high degree of common variance
with a general factor (e.g., the shared variance of the six sub-
scales on the RSS). Thus, according to scale development
researchers (e.g., Stucky & Edelen, 2014), the possibility
emerges for creating a briefer version of the RSS assessing
overall severity of spiritual struggles that also represents
the culturally and clinically relevant types of struggle that
might contibute to the etiology of and recovery from clinical
problems that lead people to seek mental health care (Parga-
ment & Exline, 2022).
Overview ofRSS‑5 Development
andEvaluation
The RSS-5 was developed via three sequential investiga-
tions to address these concerns. First, a set of five items
capturing divine, interpersonal, moral, doubt, and ultimate
meaning struggles was identified from existing datasets in
which the original version of Exline etal.’s (2014) was uti-
lized. Focusing on 711 participants in the first study who
exceeded the clinical cutoff for depression symptoms on
the Patient Health Questionnaire (PHQ-8; Kroenke etal.,
2009), bifactor modeling was utilized to identify the most
representative and superior-performing items for each form
of struggle along with analyses to test internal consistency
and convergent validity with the longer version of the RSS
and severity of depression symptoms. Drawing upon on the
selected items, we then implemented this five-item version
of the RSS in an online study with undergraduate students
(Study 2) and routine intake procedures in an integrated
behavioral health outpatient clinic (Study 3). The purpose of
these latter studies was to further examine factorial validity
and convergent/divergent validity of the RSS-5 with fuller
set of measures assessing psychological and spiritual fac-
tors that could be relevant for persons struggling with their
S/R. Given the relevance for mental health care (Bockrath
etal., 2022; Pargament & Exline, 2022), the end-goal of
these three investigations was to produce a valid, structurally
sound, and brief form of the RSS that could advance clinical
research and practice on spiritual struggles.
Several practical and methodological considerations for
this process should be highlighted. We omitted the demonic
struggles scale on the original version of Exline etal.’s
(2014) measure. Given the avoidance of S/R in many men-
tal health and healthcare settings (Saunders etal., 2010),
we were concerned that potentially skeptical clinicians and
researchers would be hesitant to implement items inquiring
about supernatural evil or demonic activity. Demonic strug-
gles also occur less often than other the forms of struggle,
particularly among secular and non-religious persons, and
do not predict mental health outcomes to the same degree
(Pargament & Exline, 2022). In combination with pref-
erences for measures with 2–5 items in many clinical or
applied contexts, we prioritized Exline etal.’s other forms
of struggle. In so doing, we attempted to identify a general
factor across the RSS subscales by sampling items from the
five domains. Historically, researchers had encountered diffi-
culty in developing a brief measure of spiritual distress with
adequate utility and psychometric strengths to justify use in
clinical settings (e.g., King etal., 2017). Hence, rather than
clinicians developing new items for their settings or choos-
ing existing items from the RSS or another scale, a psycho-
metrically validated brief version of the RSS would be ideal.
Last, we targeted depression symptoms in Study 1 due to
high prevalence in clinical samples and co-occurrence with
other psychological and physical health issues that often lead
people to seek care (NIMH, 2021). In so doing, we did not
intend to create a scale that would only apply to depressed
persons, but used a clinical cutoff on the PHQ-8 (Kroenke
etal., 2009) to identify as large cross-section of participants
from our prior studies with RSS who had a probable need
for treatment to identify the final items.
Study 1
Methods
Participants andprocedures
The first sample consisted of participants from seven previ-
ous studies using Exline etal.’s (2014) measure. Specifically,
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Journal of Psychopathology and Behavioral Assessment (2025) 47:88 Page 4 of 15
these studies included adults hospitalized in an acute psychi-
atric stabilization program in a large behavioral health center
in the U.S. Midwest (Currier, Fosteret al., 2019), veterans
seeking outpatient mental health care at a Veterans Affairs
medical center on the U.S. Gulf Coast (Raines etal., 2017),
veterans in a long-term transitional living program (Currier,
Fadoir etal., 2019), men in a residential treatment program
for substance use disorders (Currier, Fadoir etal., 2019),
student service members and veterans from two universi-
ties located on the U.S. Gulf Coast (Currier, McDermott,
McCormick etal., 2018), another group of undergraduate
students from universities on the U.S. Gulf Coast (Currier,
McDermott, Hawkins etal., 2018), and an online sample of
veterans who completed one or more war-zone deployments
(Currier etal., 2015). Of the 2,127 participants across the
seven studies, 711 met or exceeded the clinical cutoff score
of 10 for moderately severe depression symptoms on the
PHQ-8 (Kroenke etal., 2009). The average age of selected
participants was 36years old (SD = 15.5). Please refer to
Table1 for the other demographic and S/R background fea-
tures of this aggregated sample and Supplement 1 for more
details about the datasets on which Study 1 was based.
Measures
Exline etal.’s (2014) Religious and Spiritual Struggles Scale
(RSS) was used to assess ways that participants were strug-
gling with their S/R. Namely, 22 of the 26 RSS items were
used to gauge struggles with God or the divine (5 items;
e.g., “Questioned God’s love for me”), morality (4 items;
e.g., “Felt guilty for not living up to my moral standards),
absence of ultimate meaning (4 items; e.g., “Had concerns
Table 1 Demographic of
spiritual/religious backgrounds
of study participants
Factor Study 1
(N = 711)
Study 2
(N = 303)
Study 3
(N = 121)
Gender:
Male 420 (59.1%) 142 (46.9%) 65 (53.7%)
Female 287 (40.4%) 160 (52.8%) 53 (43.8%)
Transgender – – 3 (2.5%)
Race/Ethnicity:
Black 135 (19.0%) 134 (44.2%) 25 (20.7%)
White 469 (66.0%) 66 (21.8%) 92 (76.0%)
Hispanic/Latino(a) 50 (7.0%) 34 (11.2%) 5 (4.1%)
Native American 9 (1.3%) – 1 (0.8%)
Asian American 23 (1.7%) 48 (15.8%) 1 (0.8%)
Multi-Racial 25 (3.5%) 12 (4.0%) –
Other background 9 (1.3%) 7 (2.3%) 2 (1.7%)
Religious Affiliation:
Christian 401 (56.4%) 183 (60.4%) 75 (62.0%)
Atheist/None 101 (14.2%) 38 (12.5%) 11 (9.1%)
Jewish 2 (0.3%) 1 (0.3%) 1 (0.8%)
Muslim 5 (0.7%) 34 (11.2%) 2 (1.7%)
Hindu – 13 (4.3%) –
Other Religion 68 (9.6%) 2 (0.7%) 11 (9.1%)
Spiritual/Religious Identity:
Spiritual but not Religious 176 (24.8%) 31 (10.2%) –
Religious not Spiritual 42 (5.9%) – –
Both Spiritual and Religious 230 (32.3%) – –
Neither Spiritual or Religious 84 (11.8%) – –
Spiritual/Religious Endorsement:
Spiritual or Religious – – 76 (62.8%)
Connected with S/R community – – 42 (5.8%)
S/R contributed to problems – – 230 (31.7%)
S/R source of strength – – 86 (11.8%)
Suicide Risk:
Any thoughts of suicide (past 30days) – – 38 (31.4%)
Attempt suicide (past 30days) – – 1 (0.8%)
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Journal of Psychopathology and Behavioral Assessment (2025) 47:8 Page 5 of 15 8
about whether there is any ultimate purpose to life or exist-
ence), interpersonal struggles (5 items; e.g., “Had conflicts
with other people about religious/spiritual matters”), and
religious doubting (4 items; e.g., “Worried about whether
my beliefs about religion/spirituality were correct”). Each
study began with this statement to address anticipated S/R
diversity among the participants:
“It is not uncommon for people to struggle in their
spirituality or faith at different points in life. Below
you will find questions that ask about different types
of ways that people might struggle in this area. In
responding to items, please feel free to substitute an
alternate word that captures whatever “God” means to
you. For example, you may see God as a Higher Power,
Divine Being, Great Spirit, Nature, a Positive Energy
Providence, Fate, etc.”
Items were rated on a five-point scale from 1 = Not at all
to 5 = A great deal, such that higher total scores indicated
greater struggles with S/R.
The Patient Health Questionnaire (PHQ-8; Kroenke etal.,
2009) was used across studies to assess eight symptoms
of major depressive disorder (e.g., anhedonia, depressed
mood). The PHQ-8 is a widely used instrument that asks
respondents to rate the frequency of symptoms over the past
month, with scores ranging from 0 = not at all to 3 = nearly
every day. A score of 10 or above indicates symptoms that
are moderately severe or worse in nature (Kroenke etal.,
2009).
Analysis Plan
We used a combination of empirical and theory-driven
approaches to identify representative, psychometrically
strong items from the five subscales of the RSS used
across the seven studies (Divine, Interpersonal, Doubt,
Moral, Ultimate Meaning). Specifically, summative self-
report instruments with a total score and positively cor-
related subscale scores are often more unidimensional than
multidimensional (Rodriguez etal., 2016). Although the
RSS can be used as a multidimensional measure (Exline
etal., 2014), many researchers implement the measure in
a unidimensional fashion in which they solely report on
the total score. A short form representing the total RSS
score might be especially useful for research and clinical
practice. Moreover, if an instrument is unidimensional,
items that load highly on the general factor can be selected
based on empirical criteria to represent a close approxima-
tion of the total score (Stucky & Edelen, 2014). Therefore,
we used bifactor modeling via confirmatory factor analysis
(CFA) to examine the dimensionality and the reliability
of the fuller-length RSS and inform our item retention
criteria for the short form. This is possible because a bifac-
tor model partitions variance between a general factor
representing the common variation among all items and
specific factors representing the unique contributions of
subscale factors when controlling for the general factor.
Following the guidelines proposed by Rodriguez and
colleagues (2016), we selected the following ancillary
bifactor indices to identify items for a shorter (but still
internally consistent) version of the instrument: explained
common variance (ECV); item-explained common vari-
ance (IECV); percent of uncontaminated correlations
(PUC); and variations of coefficient omega such as omega
(ω), omega hierarchical (ωH), and omega hierarchical sub-
scale (ωHS). The coefficient ω represents a model-based
estimation of the internal reliability of the common vari-
ance among all items. The two variants of ω represent
variance attributable to the general factor alone (ωH) and
variance attributable to specific factors alone (ωHS). In
contrast, ECV is a model-based index of dimensional-
ity and represents the proportion of all common variance
explained by the general factor. ECV interacts with PUC
(i.e., percentage of covariance terms in the covariance
matrix, which only reflects variance from the general fac-
tor) to inform decisions about dimensionality of an instru-
ment. When PUC values are lower than 0.80, general ECV
values are greater than 0.60, and OmegaH greater than
0.70, multidimensionality is not severe enough to dis-
qualify the interpretation of the instrument as primarily
unidimensional (Reise etal., 2013). Additionally, if an
instrument is essentially unidimensional, retaining items
with variance primarily explained by the general factor
by examining IECV values can yield a shorter, unidimen-
sional version of an instrument’s total score (Stucky &
Edelen, 2014).
Stauner etal. (2016) conducted the only bifactor rep-
resentation of the RSS to date; in so doing, they found
mixed evidence for multidimensionality but did not calcu-
late ancillary bifactor indices of dimensionality or reliabil-
ity. Thus, rather than relying solely on information from
the bifactor model, we combined our empirically-driven
item retention criteria with scientific and theoretical work
on the RSS to ensure appropriate representation of the
construct. Additionally, we used commonly reported fit
indices recommended by Kline (2023) and these cut val-
ues to evaluate the overall fit of our model to the data:
comparative fit Index (CFI) and Tucker-Lewis index (TLI;
values approaching or exceeding 0.95 indicate acceptable
fit); root mean square error of approximation (RMSEA;
values close to 0.01, 0.05, and 0.08 represent excellent,
good, and marginal fit respectively); and the standardized
root mean residual (SRMR; values less than 0.08 indicate
acceptable fit).
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Journal of Psychopathology and Behavioral Assessment (2025) 47:88 Page 6 of 15
Results
Bifactor Modeling
A correlated factors model with five interrelated RSS
factors provided an acceptable fit to the data, Χ2 (199,
N = 711) = 555.31, p < 0.001, CFI = 0.951, TLI = 0.943,
RMSEA = 0.050 (90% CI = 0.045, 0.055), and
SRMR = 0.038. A bifactor model also provided an accept-
able fit, Χ2 (187, N = 711), = 508.85, p < 0.001, CFI = 0.956,
TLI = 0.945, RMSEA = 0.049 (90% CI = 0.044, 0.054), and
SRMR = 0.032. The bifactor model was a significantly better
fit than the correlated factor model, scaled ΔΧ2 (12) = 43.61,
p < 0.001. Thus, a bifactor model appeared to be an appro-
priate representation of the RSS on par with the correlated
factor model originally specified by Exline and colleagues
(2014). Table2 outlines results for comparisons between the
varying models for the RSS.
A closer examination of the ancillary bifactor indices
suggested that the RSS can be condensed into a shorter,
unidimensional measure. First, the general factor appeared
to be relatively strong; the ECV for the RSS general factor
was 0.59, suggesting that more than half of all the common
variance among RSS items was explained by the RSS gen-
eral factor. Second, the PUC was high (PUC = 0.84), indicat-
ing that approximately 84% of all correlations in the model
matrix reflected variance attributable to the RSS general
factor. Likewise, IECV values for items ranged from 0.30 to
0.81, with a majority (68%) evidencing IECV values greater
than 0.50. Thus, the majority of variance in most RSS items
was explained by a general RSS factor. Regarding reliabil-
ity, coefficient ω values suggested excellent internal consist-
ency for the RSS general factor (0.96) and values ranging
from 0.85 (moral struggles) to 0.90 (divine struggles) for the
specific factors. According to the ωH coefficient, a majority
(84%) of reliable variation in the RSS raw total score may
be attributable to the general factor. Indeed, after partition-
ing out the variance attributable to the general factor, only
between 27% (divine struggles) and 52% (interpersonal
struggles) of the reliable variation was left explained by the
specific factors, as evidenced by the ωHs model coefficients.
Item Retention
Although results suggested the RSS could be shortened into
a brief unidimensional screening measure, ancillary bifactor
indices suggested multidimensionality that would preclude
viewing the RSS as a solely unidimensional instrument. In
particular, only one item measuring S/R doubts or questions
evidenced IECV values above Stucky and Edelen’s (2014)
validated criteria for a reliable indicator of a general factor.
In other words, the RSS had sufficient multidimensionality
to preclude only selecting items with the highest loadings on
the general factor to develop a shorter, unidimensional form.
Accordingly, we drew upon previous research and theoreti-
cal conceptualizations for distinct forms of struggle assessed
on the RSS to cover the content domain (Exline etal., 2014).
To this end, we selected five items (one from each of
the five RSS subscales) to develop the RSS-5. Table3 dis-
plays the unidimensional and correlated factor loadings, as
well as the IECV values from the bifactor model for all RSS
items. In accordance with our bifactor model results, we
included two items capturing doubt and divine struggles that
were highly representative of the general RSS factor: “Felt
troubled by doubts or questions about spirituality/religion”
(doubt-related struggle, Item 24) and “Felt as though God
had abandoned me” (divine struggle, item 19). In keeping
with Exline etal.’s (2014) original findings and goals to
develop a multidimensional instrument, we also retained
three items assessing meaning, interpersonal, and moral
struggles that loaded highly on the unidimensional factor
and evidenced the strongest loadings on their respective
correlated factors: “Questioned whether life really matters”
(ultimate meaning struggle, item 7), “Felt rejected or misun-
derstood by religious/spiritual people” (interpersonal strug-
gle, item 17), and “Worried that my actions were morally or
spiritually wrong; moral struggle, item 14).
Internal Consistency
Cronbach’s alpha was 0.77 for the RSS-5 items in the aggre-
gated sample (see Table4).
Table 2 Model comparisons of RSS
Model χ2 Value df of χ2N p-value of χ2CFI TLI RMSEA 90% CI of RMSEA SRMR
(1) Correlated 5-factor RSS 555.305 199 711 < .001 .951 .943 .05 [.045, .055] .038
(2) Bifactor model 508.847 187 711 < .001 .956 .945 .049 [.044, .054] .032
(3) Unidimensional model 2702.788 209 711 < .001 .657 .621 .130 [.125, .134] .096
(4) Second order model 563.986 204 711 < .001 .95 .944 .04 [.045, .055] .032
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Journal of Psychopathology and Behavioral Assessment (2025) 47:8 Page 7 of 15 8
Convergent Validity
Scores on the RSS-5 were moderately positively correlated
with the PHQ-8 and strongly positively correlated with the
longer version of the RSS (see Table4).
Discussion
Results of this first study provide initial evidence for the
factor structure, reliability, and validity of the RSS-5. Draw-
ing upon an aggregated sample of adults from seven studies
who exceeded the clinical cutoff for depression symptoms
on the PHQ-8 (see Supplement 1 for the details), bifactor
modeling results supported a general factor that accounted
for 58.6% of the variance in RSS scores. However, consistent
with Exline etal.’s (2014) results, we also found sufficient
multidimensionality, such that a unidimensional short form
based solely on items with the strongest loadings on the gen-
eral factor would not fully capture all of the different forms
of spiritual struggles. Indeed, the general factor of the longer
RSS appeared to primarily measure doubt-related struggle
in our sample, according to the IECV values. Therefore,
five items were selected that loaded highly on the divine,
interpersonal, doubt, moral, and ultimate meaning strug-
gles, all of which also loaded highly onto the general factor.
In turn, the selected RSS-5 items demonstrated acceptable
internal consistency and convergent validity with the over-
all severity of depression symptoms. Further, scores on the
RSS-5 correlated with longer version of the RSS at 0.95,
suggesting a high degree of overlap between the two forms
of the RSS.
Study 2
Methods
Participants andProcedures
The second sample consisted of undergraduates enrolled in
a public institution in the southeastern U.S. who completed
the RSS-5 as part of a general survey to receive course credit
through the university’s online research platform between
January and April 2023. The survey also included measures
assessing sociodemographic factors, personality factors, and
psychological well-being. Participants were excluded if less
Table 3 RSS Unidimensional factor loadings, IECV values, and model fit statistics
IECV = Individual Explained Common Variance, which indicates how much of the variance is explained in the item by the general factor from a
bifactor model
RSS Item Unidimensional Factor
Loadings
Correlated Factor Load-
ings
IECV
1. Felt guilty for not living up to morals (moral) .49 .46 .52
2. Felt angry at God (divine) .69 .40 .72
3. Concerns about ultimate meaning (ultimate meaning) .65 .37 .76
4. Felt hurt/mistreated/offended by S/R people (interpersonal) .50 .62 .38
5. Struggled to figure out what I really believe (doubt) .74 .38 .79
7.Questioned whether life really matters (ultimate meaning) .67 .62 .52
8. Felt torn between what I wanted and morals (moral) .56 .56 .48
9. Questioned God’s love for me (divine) .74 .38 .77
10. Had conflicts with others about S/R (interpersonal) .49 .53 .43
12. Felt as though life had no deeper meaning (ultimate meaning) .66 .58 .53
13. Felt angry at organized religion (interpersonal) .41 .58 .30
14. Worried my actions were morally wrong (moral) .55 .61 .41
15. Felt confused about S/R beliefs (doubt) .76 .41 .78
16. Felt as though God was punishing me (divine) .71 .38 .76
17. Felt rejected/misunderstood by S/R people (interpersonal) .59 .57 .51
19. Felt as though God had abandoned me (divine) .76 .55 .61
20. Worried whether S/R beliefs were correct (doubt) .62 .46 .61
21. Wrestled with attempts to follow morals (moral) .60 .56 .52
22. Questioned if life will make any difference (ultimate meaning) .66 .56 .56
23. Felt as though God had let me down (divine) .72 .53 .61
24. Felt troubled by S/R doubts or questions (doubt) .77 .37 .81
26. Felt that others were looking down on me (interpersonal) .48 .55 .42
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Journal of Psychopathology and Behavioral Assessment (2025) 47:88 Page 8 of 15
than 50% of the survey was completed, they finished in less
than 5min, or they failed more than half of validity checks.
The final sample included 303 participants with an average
age of 22years (SD = 4.9). Please refer to Table1 for other
demographic and S/R features of the participants.
Measures
In addition to the RSS-5 developed in Study 1, participants
completed S/R background items and the below measures
of mental health symptoms and well-being (see Table1).
Depression The CES-D (Radloff, 1977) is a 20-item meas-
ure that assesses the extent to which symptoms of depression
have been experienced over the past week. Response options
range from 0 = Rarely or none of the time to 3 = Most or all
of the time; total scores range from 0 to 60, with a score of
16 or higher indicating severity of depressive symptoms in
the clinical range that indicate a probable need for a clinical
intervention.
Anxiety The STAI-S (Spielberger, 1983) is another self-
report measure that consists of 20 items assessing anxiety
symptoms at the moment of administration. Responses are
scored on a 4-point scale ranging from 1 = Not at all to
4 = Very much so; total scores of 40 and higher are consid-
ered to indicate probable clinical levels of anxiety symp-
tomatology that might indicate a need for treatment.
Meaning The Meaning in Life Questionnaire (Steger etal.,
2006) is a 10-item measure assessing the presence of mean-
ing (five items) and search for meaning in life (five items).
Item responses range from 1 = “Absolutely Untrue” to
7 = “Absolutely True.” Example items include: “I understand
my life’s meaning” (presence of meaning item) and “I am
looking for something that makes my life feel meaningful”
(search for meaning in life item).
Life Satisfaction Satisfaction with Life Scale (SWLS;
Diener etal., 1985) is a 5-item measure assessing the extent
of one’s life satisfaction. Example items include: “In most
ways my life is close to my ideal” and “If I could live my
life over, I would change almost nothing.” Items are rated
on a 7-point scale ranging from 1 = “Strongly disagree” to
7 = “Strongly agree.” Total scores above 20 indicate some
extent of life satisfaction (Diener etal., 1985).
Table 4 Descriptive statistics
of study measures and bivariate
correlations for study 1, 2, and
3 samples
S/R = spirituality and/or religious faith; SD = standard deviation. *p < .05, **p < .001
Cronbach’s
alpha
Mean (SD) Correlation with
RSS-5 Total
Score
Study 1 Sample (N = 711)
RSS-5 total score 0.77 12.08 (5.10) –-
Depression (PHQ-8) 0.74 16.17 (4.49) 0.40**
RSS total score (without demonic) 0.94 53.60 (19.96) 0.95**
Study 2 (N = 303)
RSS-5 total score 0.82 9.19 (4.43)
Depression (CES-D) 0.91 39.14 (11.54) 0.50**
Anxiety (STAI-S) 0.94 40.88 (12.40) 0.43**
Meaning- Search (MLQ-Search) 0.84 25.72 (6.21) 0.18*
Meaning- Presence (MLQ-Presence) 0.88 24.22 (6.66) −0.39**
Life Satisfaction (SWLS) 0.82 21.03 (6.27) −0.33**
Flourishing Scale 0.87 88.24 (18.84) −0.43**
Study 3 (N = 121)
RSS-5 total score 0.85 9.86 (5.03) –-
Psychological Distress (CORE-10) 0.90 18.35 (9.65) 0.61**
Depression (PHQ-2) 0.91 3.15 (2.22) 0.44**
Anxiety (GAD-2) 0.87 3.55 (2.13) 0.51**
Suicidal thoughts past month 1.67 (1.52) 0.49**
Suicide attempts past month 1.01 (0.20)
S/R affiliation 0.14
Connection with S/R community −0.06
S/R contributing to problems 0.33**
S/R is a strength 0.07
Interest in integrating S/R in treatment 0.22*
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Journal of Psychopathology and Behavioral Assessment (2025) 47:8 Page 9 of 15 8
Flourishing The Flourishing Measure (VanderWeele,
2017b) is a 12-item measure that assesses happiness and
life satisfaction (Items 1–2; e.g., “Overall, how satisfied are
you with life as a whole these days?”), mental and physical
health (Items 3–4; e.g., “In general, how would you rate your
physical health?”), meaning and purpose (Items 5–6; e.g.,
“Overall, to what extent do you feel the things you do in your
life are worthwhile?), character and virtue (Items 7–8; e.g.,
“I always act to promote good in all circumstances, even in
difficult and challenging situations), close social relation-
ships (Items 9–10; e.g., “I am content with my friendships
and relationships), and financial and material stability (Items
11–12; “How often do you worry about being able to meet
normal monthly living expenses?”). Item responses range
from a 0–10 scale, with response anchors from “Extremely
Unhappy” to “Extremely Happy,” “Strongly Disagree” to
“Strongly Agree,” and “Poor” to “Excellent.”
Analysis Plan
We first confirmed the factor structure of the RSS-5 via
structural equation modeling. Specifically, we specified a
unidimensional factor structure and evaluated the model
based on same indices of fit detailed in Study 1. Descriptive
statistics of the RSS-5, internal consistency, and convergent
validity were then calculated in this undergraduate sample.
Results
Preliminary Analysis
All missing items for demographic, psychological, and well-
being measures accounted for less than 1% of the sample.
Overall, 52.6% of participants scored in the clinical range for
depression symptoms on the CES-D and 51.5% scored above
the clinical cutoff for anxiety symptoms on the STAI-S.
Primary Analysis
Internal Consistency The RSS-5 items yielded a Cron-
bach’s alpha of 0.82 in the second sample (see Table4).
Factorial Validity The unidimensional RSS-5 evidenced
excellent fit to the data in the aggregated validation sam-
ples, Χ2 (5, N = 303) = 14.326, p = 0.0137, CFI = 0.966,
TLI = 0.933, RMSEA = 0.078 (90% CI = 0.032, 0.128), and
SRMR = 0.036. Of note, the RMSEA, which was the only
index of fit that was marginal for the RSS-5, has been shown
not to be as reliable in models with smaller degrees of free-
dom (Kenny & McCoach, 2003; Kenny etal., 2015).
Convergent/Divergent Validity Bivariate correlations
between participants’ RSS-5 scores and indices of negative
and positive mental health are presented in Table4. RSS-5
scores were strongly positively correlated with mental health
symptoms on the CES-D and STAI-S. The RSS-5 was also
positively linked with MLQ – search for meaning. In con-
trast, RSS-5 scores were moderately negatively correlated
with responses on the MLQ – presence of meaning, SWLS,
and Flourishing Scale.
Discussion
Focusing on an undergraduate sample, Study 2 provided
additional important information about the factor structure,
reliability, and construct validity of the RSS-5. CFA results
supported the use of the RSS-5 as a unidimensional measure.
Internal consistency was also again in a favorable range and
remaining analyses supported construct validity of the meas-
ure. Specifically, in keeping with research with the original
version of the RSS (e.g., Bockrath etal., 2022; Damen etal.,
2021; Currier etal., 2019a; Leavitt-Alcantara etal., 2023;
Murphy etal., 2016), RSS-5 scores were strongly positively
associated with depression and anxiety symptoms; search
for meaning was linked with RSS-5 scores at moderate level.
In contrast, RSS-5 scores were highly inversely linked with
perceived presence of meaning in life, life satisfaction, and
flourishing. Additionally, it is important to note the high lev-
els of distress in this undergraduate sample. There could be
multiple factors to consider regarding these rates of distress,
including sampling from a racially and ethnically diverse
university, socio-economic status of students, or even cohort
effects such as attending college following the height of the
COVID pandemic.
Study 3
Methods
Participants andProcedures
The last sample consisted of 121 adults who completed the
RSS-5 between December 2021 and December 2022 as
part of routine intake procedures in an integrated behav-
ioral health outpatient clinic that offers evidence-based
psychotherapies, primary care, and peer support to persons
who are struggling with mental health and/or substance use
disorders. The clinic is certified as an outpatient substance
abuse treatment program by the mental health department
in the state in which it is located and received a Certified
Community Behavioral Health Clinic (CCBHC) Expansion
Grant from SAMHSA in August 2021. Although the organi-
zation specializes in caring for military service members,
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Journal of Psychopathology and Behavioral Assessment (2025) 47:88 Page 10 of 15
veterans, first responders, and their family members, the
clinic also serves persons who did not serve in the military.
The organization serves patients from religiously diverse
backgrounds (including non-religious), such that clinicians
are expected to honor patients’ preferences, needs, goals, and
cultural beliefs and values in all cases. The average age of
participants was 40years old (SD = 14.4). Demographic and
S/R backgrounds for the third sample are outlined in Table1.
Measures
In addition to the RSS-5, participants completed the below
assessments of mental health symptomatology and chal-
lenges in the intake questionnaire:
Spirituality S/R background factors were asked on a yes/no
response (0 = No, 1 = Yes): affiliation (“Do you view yourself
as a religious and/or spiritual person?”), connection with
a community (“Are you connected with a religious and/or
spiritual community?”), problems (“Has your religious faith
and/or spirituality contributed to some of your problems?”),
source of strength (“Has your religious faith and/or spiritual-
ity been a source of strength in your life?”), and preferences
for treatment (“Would you like to explore ways of including
your faith and/or spirituality in your care?”).
Psychological Distress The CORE-10 (Barkham etal.,
2013) is a 10-item measure of common symptoms of psy-
chological distress. Assessed on a five-point scale with
anchor points of 0 = Not at all to 4 = Most or all of the time,
items on this well-established instrument for tracking out-
comes in psychotherapy capture symptoms of anxiety (e.g.,
“I have felt tense or anxious”), depression (e.g., “I have felt
despairing or hopeless”), suicide risk (e.g., “I made plans to
end my life”), and psychosocial and relational functioning
(e.g., “I have felt able to cope when things go wrong, “I have
felt that I have someone to turn to when needed” [reverse
scored]). Scores of 10 or higher suggest clinical levels of
psychological distress.
Depression The PHQ-2 is an abbreviated version of the
PHQ-8 that is composed of two items to screen for possible
major depressive disorder (Kroenke etal., 2003). Items are
scored from 0 = Never to 3 = Nearly Every Day, such that
higher scores indicated greater depression symptoms. A total
score of 3 or higher indicate a probable need for treatment.
Anxiety The GAD-2 is an abbreviated version of the
GAD-7 that consists of two items screening for general-
ized anxiety disorder. Items are scored from 0 = Never to
3 = Nearly Every Day, with a total of 3 indicating a probable
need for treatment for anxiety (Kroenke etal., 2007).
Suicidality Items from the revised version of Osman etal.’s
(2001) Suicidal Behavior Questionnaire (SBQ-R) was used
to assess frequency of suicidal ideation over past 30days and
the likelihood of attempting suicide in the future. The item
assessing suicidal ideation was scored on a five-point scales
in which 1 = “Never” and 5 = “Very Often” and attempt
probability was assessed on a seven-point scale in which
0 = “Never” and 5 = “Very Likely.”
Analysis Plan
In keeping with the analytic approach in Study 2, we again
confirmed the RSS-5 via CFA. Then, we calculated descrip-
tive statistics of the RSS-5, internal consistency, convergent
and incremental validity in this outpatient treatment-seeking
sample.
Results
Preliminary Analysis
Initial frequency analyses revealed roughly 75% of partici-
pants scored above the clinical cutoff for psychological dis-
tress on the CORE-10, 44% of participants scored in the
clinical range for depression symptoms on the PHQ-2, and
65% exceeded the threshold for anxiety symptoms on the
GAD-2. Nearly 30% of the participants reported thoughts
of suicide at least once in the past 30days. The sample con-
tained no missing values for demographic items and psycho-
logical measures at rates higher than 1% on all items.
Internal Consistency
The RSS-5 items yielded a Cronbach’s alpha of 0.85 in the
third sample.
Factorial Validity
The unidimensional RSS-5 again evidenced excellent fit
to the data in the clinical sample, Χ2 (5, N = 121) = 16.344,
p = 0.006, CFI = 0.931, TLI = 0.862, RMSEA = 0.137
(90% CI = 0.067, 0.213), and SRMR = 0.045. Of note, the
RMSEA, which was the only index of fit that was mar-
ginal for the RSS-5, has been shown not to be trustworthy
(inflated) in models with small degrees of freedom (Kenny
& McCoach, 2003; Kenny etal., 2015).
Convergent Validity
Bivariate correlations between participants’ RSS-5 scores and
their S/R backgrounds and mental health symptoms are pre-
sented in Table4. Scores on the RSS-5 were not associated
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Journal of Psychopathology and Behavioral Assessment (2025) 47:8 Page 11 of 15 8
with religious affiliation, connection with spiritual/religious
community, or endorsement of S/R as a source of strength. In
contrast, RSS-5 scores were moderately positively correlated
with endorsement of S/R contributing to problems, and inter-
est in including S/R in their care. In addition, RSS-5 scores
were moderately to strongly correlated with psychological
distress, as well as depression, anxiety, and suicidal ideation,
all ps < 0.001 (See Table4).
Incremental Validity
When controlling for scores on the PHQ-2 and GAD-2 in
an initial step, we added RSS-5 scores in a second step to
examine incremental validity in predicting suicidal ideation
in the presence of depression and anxiety symptoms. In total,
PHQ-2 and GAD-2 scores significantly explained patients’ dif-
ferences in suicidal ideation in the first step, ∆R2 = 0.21, Fchange
(2, 112) = 14.78, p < 0.001. The addition of RSS-5 scores also
significantly increased the explained variance in the second
study, ∆R2 = 0.15, Fchange (1, 111) = 26.49, p < 0.001.
Discussion
The RSS-5 again demonstrated factorial validity, internal con-
sistency and evidence of construct validity in a clinical sample
of adults seeking psychotherapy/counseling and/or primary
care in an integrated behavioral health clinic. CFA findings
supported a unidimensional factor structure and internal con-
sistency was 0.85. RSS-5 scores were not associated with sev-
eral S/R background factors (religious affiliation, connection
with a spiritual/religious community, endorsement of S/R as
a source of strength), possibly suggesting the distinctness of
the measure from general indices of religiousness or spiritu-
ality S/R and applicability to many persons from across the
spectrum of religiousness (including secular or non-religious).
However, as one may anticipate, patients who endorsed S/R
contributing to their problems and interest in exploring inclu-
sion in their care generally had higher scores on the RSS-5. In
keeping with Study 1 and 2, RSS-5 scores were also moder-
ately to strongly correlated with greater mental health symp-
toms (psychological distress, depression, anxiety, and suicidal
ideation) in this last sample. Consistent with the incremental
validity of the original RSS in predicting suicide in other treat-
ment-seeking samples (e.g., Raines etal., 2017), scores on the
RSS-5 were also uniquely linked with suicidal ideation in the
presence of depression and anxiety symptoms.
General Discussion
An amassing scientific literature highlights the importance
of addressing spiritual struggles in clinical practice and
research (Pargament & Exline, 2022). Notwithstanding
the psychometric strengths of 14- and 26-item versions of
the Religious and Spiritual Struggles Scale (RSS; Exline
etal., (2014, 2022), a five-item version of the RSS might
facilitate these advances. Overall, results from the three
studies revealed the RSS-5 represents a structurally sound
and reliable instrument for assessing the common forms of
spiritual struggles from Exline etal.’s framework. Namely,
even with reducing the measure to five items, internal
consistency of the RSS-5 ranged from 0.77 to 0.85. In
addition, scores on this short form overlapped highly with
the original version of the RSS in Study 1 and were mod-
erately to strongly associated with validated assessments
of positive (well-being, flourishing, and perceived mean-
ing in life) and negative (suicide ideation, depression and
anxiety symptoms) mental health across the three studies.
When accounting for scores on validated short forms of
instruments assessing symptoms of major depressive dis-
order (PHQ-2) and generalized anxiety disorder (GAD-2),
the RSS-5 also demonstrated incremental validity in pre-
dicting patients’ suicidal ideation over the past months in
the clinical sample. In combination, these latter findings
affirm the clinical relevance of spiritual struggles, assessed
by the RSS-5, in varying indices of positive and negative
mental health (e.g., Currier etal., 2015, 2018a, 2018b,
2019a, 2019b; Lemke etal., 2023; Wilt etal., 2017).
Although we supported a unidimensional factor structure
for the RSS-5, there was also evidence of multidimensional-
ity for selected items in Study 1 that aligned with psycho-
metric findings for the original version (Exline etal., 2014;
Stauner etal., 2016). From a practical view, clinicians and
researchers might therefore use the total score of the RSS-5
to gauge the overall severity of spiritual distress with confi-
dence that items in this short form also capture distinct ways
that people who are experiencing mental health challenges
often struggle with their S/R (divine, interpersonal, doubt,
moral, and ultimate meaning struggles; Pargament & Exline,
2022). In keeping with Study 3, including the RSS-5 in an
intake questionnaire could help clinicians to identify ways
that patients could be struggling with their S/R. Namely, if
patients endorse certain items as “Somewhat,” “Quite a bit,”
or a “A great deal,” clinicians might inquire further about
the specific forms of struggle and how these issues relate
with the presenting problem(s) and are causing distress and
maladaptive coping. However, whether focusing on longer
versions or this short form, research will ideally identify a
cutoff or threshold score on the RSS for determining clinical
levels of spiritual distress to aid clinicians in case formula-
tion and treatment planning. In doing so, emerging findings
indeed suggest that many patients who are struggling with
their S/R might benefit from clinicians offering a higher dos-
age of treatment and specifically attending to these issues in
the therapeutic process (Currier etal., 2024; Pargament &
Exline, 2022).
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Journal of Psychopathology and Behavioral Assessment (2025) 47:88 Page 12 of 15
When spiritual struggles are co-occurring with other
mental health challenges, clinicians and researchers might
also use the RSS-5 in routine outcome monitoring (ROM).
Research has supported the benefits of ROM (Barkham
etal., 2023; Lambert etal., 2018). By tracking spiritual
struggles and psychological outcomes on a session-to-
session basis, practitioners of spiritually integrated psy-
chotherapies might enhance engagement of patients who
are struggling with their S/R and tailor treatment in ways
that facilitate resolution of these issues and other clinical
outcomes (e.g., reduce mental health symptoms, improve
psychosocial functioning). When patients who are experi-
encing spiritual struggles are not improving, ROM might
also signal a need for a change or modification of the treat-
ment plan that might include a more deliberate exploration
or processing of these issues, referral to a clergy person or
other spiritual care professional, or other approaches (for
a thorough discussion of clinical strategies, see Pargament
& Exline, 2022). Relatedly, the RSS-5 might also support
practice-based evidence research to identify interventions
that might support transformation of spiritual struggles in
psychotherapy. Notwithstanding evidence-based protocols
for addressing spiritual struggles (e.g., Harris etal., 2018),
such studies might guide clinicians to address spiritual strug-
gles as a routine part of their practice. However, in addi-
tion to clarifying a clinical cutoff, research is also needed
to determine clinically and reliable change on the RSS that
might signify a successful treatment.
Without overlooking these possibilities, several limita-
tions should be mentioned when considering implementing
the RSS-5 in clinical practice and research. First, we utilized
a cross-sectional design and cannot draw temporal infer-
ences or make causal statements regarding spiritual strug-
gles and outcomes in the three studies. Although research
with the original RSS has documented temporal stability
and precedence for spiritual struggles in predicting mental
health symptoms over time (Bockrath etal., 2022), longitu-
dinal studies are needed to determine test–retest reliability
and predictive validity of the RSS-5. Second, we exclusively
relied on self-report instruments for assessing depression
and anxiety in ways that limit our ability to determine rates
of diagnoses in the three samples and the sensitivity of the
RSS-5 to detecting cases for these conditions. Research will
ideally utilize clinical interviewing with a fuller range of
mental health conditions to further evaluate construct valid-
ity of the RSS-5. Information on clinical diagnoses would
also be needed for identifying a clinical cutoff and thresh-
old for clinically significant change. Third, we also lacked
data about the utility of the RSS-5 for evaluating treatment
outcomes. Although the measure performed well as part of
an intake questionnaire in the integrated behavioral health
clinic in Study 3, we did not track patients’ health-related
outcomes over time. As highlighted above, clinical research
will ideally examine utility of the RSS-5 in routine outcome
monitoring procedures in psychotherapy or other treatments.
Fourth, demonic struggles were not included in our analyses.
Though we do not consider this to be a significant weakness,
it is a psychometric limitation of our findings. In reviewing
Stauner etal., (2016), the bifactor results of Study 1 were
similar with regard to item loadings on the general factor and
specific factors, and we predict that demonic struggles would
not have had a significant impact on the bifactor and item
retention results of the RSS-5. In addition, while bifactor
analysis is a strong tool for partitioning variance and under-
standing the reliability and dimensionality of an instrument,
it is typically the least parsimonious model and can over-
extract factors, so it may not be consistent with the underly-
ing theory of a construct if the measure is not orthogonal
(Bonifay etal., 2017). Looking ahead, research will ideally
build on our psychometric findings for the RSS-5 with these
methodological considerations in mind.
With these limitations in mind, the RSS-5 provides a
brief, psychometrically-validated tool for assessing spir-
itual struggles in clinical practice and research. In conclu-
sion, we supported a one-factor solution for the measure
while detecting evidence for multidimensionality in Study
1 for selected items in ways that converged with previous
research on the original RSS (Exline etal., 2014; Stauner
etal., 2016). Taken together, the three studies also yielded
evidence for internal consistency and validity of the RSS-5
(convergent, divergent, and incremental). Although more
research is needed along the lines described above, the
RSS-5 might represent a viable tool for assessing spiritual
struggles in mental health care settings. Looking ahead,
having a short form of the RSS will hopefully advance
translational research on spiritual struggles that might
facilitate innovation for clinicians to tailor evidence-based
interventions and/or develop novel approaches for address-
ing these issues in their practice.
Supplementary Information The online version contains supplemen-
tary material available at https:// doi. org/ 10. 1007/ s10862- 024- 10182-9.
Author contributions All authors significantly contributed to this man-
uscript. Authors 1–3 made substantial contributions to the conception
and design of the study and overall manuscript. Authors 2 and 4–6
contributed to acquisition of data, while all authors made substantial
contributions to the analysis and interpretation of data. Authors 1–3
substantially contributed to drafting the manuscript, and all authors
provided critical revisions of the manuscript for important intellectual
content.
The submitted manuscript represents valid work and neither this
manuscript nor one with substantially similar content in which any
of these contributing authors have authorship on have been published
or are being considered for publication elsewhere. The first author
will serve as the primary correspondent with the editorial office, will
review the edited typescript and proof, and make decisions regard-
ing the release of information in the manuscript to the media, federal
agencies, or both.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Journal of Psychopathology and Behavioral Assessment (2025) 47:8 Page 13 of 15 8
Declarations
Competing Interests There are no financial or competing interests to
report. Study data was reviewed/approved by the IRB from the Uni-
versity of South Alabama.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
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References
Abu-Raiya, H., Exline, J. J., Pargament, K. I., & Agbaria, Q. (2015).
Prevalence, Predictors, and Implications of Religious/Spiritual
Struggles Among Muslims. Journal for the Scientific Study of
Religion, 54(4), 631–648. https:// doi. org/ 10. 1111/ jssr. 12230
Abu-Raiya, H., Pargament, K. I., Weissberger, A., & Exline, J. (2016).
An Empirical Examination of Religious/Spiritual Struggle Among
Israeli Jews. The International Journal for the Psychology of Reli-
gion, 26(1), 61–79. https:// doi. org/ 10. 1080/ 10508 619. 2014. 10035 19
Barkham, M., Bewick, B., Mullin, T., Gilbody, S., Connell, J., Cahill,
J., Mellor-Clark, J., Richards, D., Unsworth, G., & Evans, C.
(2013). The CORE-10: A short measure of psychological dis-
tress for routine use in the psychological therapies. Counselling
& Psychotherapy Research, 13(1), 3–13. https:// doi. org/ 10. 1080/
14733 145. 2012. 729069
Barkham, M., De Jong, K., Delgadillo, J., & Lutz, W. (2023). Routine
Outcome Monitoring (ROM) and Feedback: Research Review
and Recommendations. Psychotherapy Research, 33(7), 841–855.
https:// doi. org/ 10. 1080/ 10503 307. 2023. 21811 14
Bockrath, M. F., Pargament, K. I., Wong, S., Harriot, V. A., Pomerleau,
J. M., Homolka, S. J., Chaudhary, Z. B., & Exline, J. J. (2022).
Religious and spiritual struggles and their links to psychological
adjustment: A meta-analysis of longitudinal studies. Psychology
of Religion and Spirituality, 14, 283–299.
Bonifay, W., Lane, S. P., & Reise, S. P. (2017). Three concerns with
applying a bifactor model as a structure of psychopathology. Clini-
cal Psychological Science, 5(1), 184–186.
Cowden, R. G., Pargament, K. I., Chen, Z. J., Davis, E. B., Lemke,
A. W., Glowiak, K. J., Rueger, S. Y., & Worthington, E. L., Jr.
(2021). Religious/spiritual struggles and psychological distress: A
test of three models in a longitudinal study of adults with chronic
health conditions. Journal of Clinical Psychology, 78(4), 544–
558. https:// doi. org/ 10. 1002/ jclp. 23232
Currier, J. M., Holland, J. M., & Drescher, K. D. (2015). Spirituality
factors in the prediction of outcomes of PTSD treatment for mili-
tary veterans. Journal of Traumatic Stress, 28, 57–64.
Currier, J. M., McDermott, R. C., Hawkins, D. E., Greer, C. L., & Car-
penter, R. (2018). Seeking help for religious and spiritual strug-
gles: Exploring the role of mental health literacy. Professional
Psychology: Research and Practice, 49(1), 90–97. https:// doi. org/
10. 1037/ pro00 00151
Currier, J. M., McDermott, R. C., McCormick, W. H., Churchwell,
M. C., & Milkeris, L. (2018). Exploring cross-lagged associa-
tions between spiritual struggles and risk for suicidal behavior
in a community sample of military veterans. Journal of Affective
Disorders, 230, 93–100. https:// doi. org/ 10. 1016/j. jad. 2018. 01. 009
Currier, J. M., Fadoir, N., Carroll, T. D., Kuhlman, S., Marie, L., Tay-
lor, S. E., Smith, T., Isaak, S. L., & Sims, B. M. (2019). A cross-
sectional investigation of divine struggles and suicide risk among
men in early recovery from substance use disorders. Psychology
of Religion and Spirituality, 12(3), 324–333. https:// doi. org/ 10.
1037/ rel00 00286
Currier, J. M., Foster, J., Witvliet, C. V. O., Abernethy, A., Root
Luna, L., Schnitker, S., Van Harn, K., & Carter, J. (2019).
Spiritual struggles and mental health outcomes in a spiritually
integrated inpatient program. Journal of Affective Disorders,
249, 127–135.
Currier, J. M., McDermott, R. C., Sanders, P., Barkham, M., Owen, J.,
Saxon, D., & Richards, P. S. (2024). Practice-based evidence for
spiritually integrated psychotherapies: Examining trajectories of
psychological and spiritual distress. Journal of Counseling Psy-
chology, 71(4), 291–303. https:// doi. org/ 10. 1037/ cou00 00727
Damen, A., Exline, J., Pargament, K., Yao, Y., Chochinov, H., Ema-
nuel, L., Handzo, G., Wilkie, D. J., & Fitchett, G. (2021). Preva-
lence, Predictors and Correlates of Religious and Spiritual Strug-
gles in Palliative Cancer Patients. Journal of Pain and Symptom
Management, 62(3), e139–e147. https:// doi. org/ 10. 1016/j. jpain
symman. 2021. 04. 024
Davis, E. B., Granqvist, P., & Sharp, C. (2021). Theistic relational
spirituality: Development, dynamics, health, and transformation.
Psychology of Religion and Spirituality, 13(4), 401–415.
Davis, E. B., Worthington, E. L., Jr., & Schnitker, S. A. (2023). Hand-
book of positive psychology, religion, and spirituality. Springer.
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The
Satisfaction with Life Scale. Journal of Personality Assessment,
49, 71–75.
Exline, J. J. (2013). Religious and spiritual struggles. In K. I. Parga-
ment (Ed.), APA handbook of psychology, religion, and spiritual-
ity: Vol. 1. Context, theory, and research (pp. 459–475). American
Psychological Association.
Exline, J., Yali, A. M., & Sanderson, W. C. (2000). Guilt, discord, and
alienation: The role of religious strain in depression and suicidal-
ity. Journal of Clinical Psychology, 56, 1481–1496.
Exline, J. J., Pargament, K. I., Grubbs, J. B., & Yali, A. M. (2014). The
religious and spiritual struggles scale: Development and initial
validation. Psychology of Religion and Spirituality, 6, 208–222.
Exline, J. J., Przeworski, A., Peterson, E. K., Turnamian, M. R.,
Stauner, N., & Uzdavines, A. (2021). Religious and spiritual
struggles among transgender and gender-nonconforming adults.
Psychology of Religion and Spirituality, 13(3), 276–286. https://
doi. org/ 10. 1037/ rel00 00404
Exline, J. J., Pargament, K. I., Wilt, J. A., Grubbs, J. B., & Yali, A. M.
(2022). The RSS-14: Development and preliminary validation of
a 14-item form of the Religious and Spiritual Struggles Scale.
Psychology of Religion and Spirituality. https:// doi. org/ 10. 1037/
rel00 00472
Gallup (2020). Religion. Retrieved from, https:// news. gallup. com/ poll/
1690/ relig ion. aspx. Accessed 6 Nov 2021.
Harris, J. I., Usset, T., Voecks, C., Thuras, P., Currier, J. M., & Erbes,
C. (2018). Spiritually integrated care for PTSD: A randomized
controlled trial of “Building Spiritual Strength.” Psychiatry
Research, 267, 420–428.
Kenny, D. A., & McCoach, D. B. (2003). Effect of the Number of
Variables on Measures of Fit in Structural Equation Modeling.
Structural Equation Modeling: A Multidisciplinary Journal,
10(3), 333–351. https:// doi. org/ 10. 1207/ S1532 8007S EM1003_1
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Journal of Psychopathology and Behavioral Assessment (2025) 47:88 Page 14 of 15
Kenny, D. A., Kaniskan, B., & McCoach, D. B. (2015). The Perfor-
mance of RMSEA in Models With Small Degrees of Freedom.
Sociological Methods & Research, 44(3), 486–507. https:// doi.
org/ 10. 1177/ 00491 24114 543236
King, S. D. W., Fitchett, G., Murphy, P. E., Pargament, K. I., Harrison, D.
A., & Loggers, E. T. (2017). Determining best methods to screen for
religious/spiritual distress. Supportive Care in Cancer: Official Jour-
nal of the Multinational Association of Supportive Care in Cancer,
25(2), 471–479. https:// doi. org/ 10. 1007/ s00520- 016- 3425-6
Kline, R. B. (2023). Principles and practice of structural equation
modeling (5th ed.). Guilford Press.
Koenig, H. G., VanderWeele, T., & Peteet, J. (2023). Handbook of
religion and health (3rd ed.). Oxford University Press.
Krause, N., Pargament, K. I., Hill, P. C., Wong, S., & Ironson, G.
(2017). Exploring the relationships among age, spiritual strug-
gles, and health. Journal of Religion, Spirituality & Aging, 29(4),
266–285. https:// doi. org/ 10. 1080/ 15528 030. 2017. 12858 44
Krause, N., Pargament, K. I., Hill, P. C., & Ironson, G. (2018). Assess-
ing the role of race/ethnicity in the relationships among spiritual
struggles, health, and well-being. American Journal of Orthopsy-
chiatry, 88(2), 132–141. https:// doi. org/ 10. 1037/ ort00 00255
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2003). The Patient
Health Questionnaire-2: Validity of a two-item depression
screener. Medical Care, 41(11), 1284–1292. https:// doi. org/ 10.
1097/ 01. MLR. 00000 93487. 78664. 3C
Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., &
Löwe, B. (2007). Anxiety Disorders in Primary Care: Prevalence,
Impairment, Comorbidity, and Detection. Annals of Internal Med-
icine, 146(5), 317–325. https:// doi. org/ 10. 7326/ 0003- 4819- 146-
5- 20070 3060- 00004
Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B. W., Berry,
J. T., & Mokdad, A. H. (2009). The PHQ-8 as a measure of cur-
rent depression in the general population. Journal of Affective
Disorders, 114(1–3), 163–173. https:// doi. org/ 10. 1016/j. jad. 2008.
06. 026
Lambert, M. J., Whipple, J. L., & Kleinstäuber, M. (2018). Collect-
ing and delivering progress feedback: A meta-analysis of routine
outcome monitoring. Psychotherapy, 55(4), 520–537. https:// doi.
org/ 10. 1037/ pst00 00167
Leavitt-Alcántara, S., Betz, J., Medeiros Almeida, D., Ferrara, B., Xu,
Y., Diop, E., Hamilton, O., Young, C., & Ragsdale, J. R. (2023).
Religiosity and religious and spiritual struggle and their asso-
ciation to depression and anxiety among adolescents admitted to
inpatient psychiatric units. Journal of Health Care Chaplaincy,
29(1), 1–13. https:// doi. org/ 10. 1080/ 08854 726. 2022. 20402 27
Lemke, A. W., Davis, E. B., Voytenko, V. L., Cowden, R. G., Chen, Z.
J., McConnell, J. M., Pargament, K. I., Phillips, K. P., Marseilles,
R., & Wolff, R. P. (2023). Religious/Spiritual Struggles and Sui-
cide Ideation Among Adult Psychiatric Outpatients: A 12-Month
Longitudinal Study. Journal of Affective Disorders Reports, 14,
100640. https:// doi. org/ 10. 1016/j. jadr. 2023. 100640
Martoyo, I., Aditya, Y., Sani, R., & Pramono, R. (2019). Religious
and spiritual struggle among Indonesian students: Who struggle
more, males or females? (pp. 329–337). https:// doi. org/ 10. 2991/
iciap- 18. 2019. 28
Mercadante, L. (2020). Spiritual Struggles of Nones and ‘Spiritual but
Not Religious’ (SBNRs). Religions, 11(10), 513. https:// doi. org/
10. 3390/ rel11 100513
Miller, L., Bansal, R., Wickramaratne, P., Hao, X., Tenke, C., Weiss-
man, M. M., & Peterson, B. S. (2014). Neuroanatomical correlates
of religiosity and spirituality: A study in adults at high and low
familial risk for depress. JAMA Psychiatry, 71, 128–135.
Murphy, P. E., Fitchett, G., & Emery-Tiburcio, E. E. (2016). Reli-
gious and spiritual struggle: Prevalence and correlates among
older adults with depression in the BRIGHTEN Program. Mental
Health, Religion & Culture, 19(7), 713–721. https:// doi. org/ 10.
1080/ 13674 676. 2016. 12441 78
National Institute of Mental Health (NIMH). (2021). Major Depres-
sion. National Institute of Mental Health (NIMH).
Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B.
A., & Barrios, F. X. (2001). The suicidal behavior questionnaire-
revised (SBQ-R): Validation with clinical and non-clinical sam-
ples. Assessment, 8, 443–454.
Pargament, K. I. (2007). Spiritually integrated psychotherapy: Under-
standing and addressing the sacred. Guilford.
Pargament, K. I., & Exline, J. J. (2022). Working with spiritual strug-
gles in psychotherapy: From research to practice. Guilford Press.
Pargament, K. I., & Lomax, J. W. (2013). Understanding and address-
ing religion among people with mental illness. World Psychia-
try: Official Journal of the World Psychiatric Association (WPA),
12(1), 26–32. https:// doi. org/ 10. 1002/ wps. 20005
Pargament, K., Feuille, M., & Burdzy, D. (2011). The Brief RCOPE:
Current psychometric status of a short measure of religious cop-
ing. Religions, 2, 51–76.
Pargament, K. I., Falb, M. D., Ano, G. G., & Wacholtz,. (2013). The
religious dimension of coping: Advances in theory, research, and
practice. In R. F. Paloutzian & C. L. Park (Eds.), Handbook of the
psychology of religion and spirituality (2nd ed., pp. 560–579).
Guilford.
Park, C. L. (2013). Religion and meaning. In R. F. Paloutzian & C. L.
Park (Eds.), Handbook of the psychology of religion and spiritual-
ity (2nd ed., pp. 357–379). Guilford.
Pew Research Center (2015). US Religious Landscape Study. http://
www. pe wfo rum. org/ relig ious- lands cape- study/ belief- in- god/ Pew-
Templ eton. Accessed 6 Nov 2021.
Pew Research Center. (2017, April 5). The Changing Global Religious
Landscape. Pew Research Center’s Religion & Public Life Project.
https:// www. pewfo rum. org/ 2017/ 04/ 05/ the- chang ing- global- relig
ious- lands cape/.Accessed 6 Nov 2021.
Radloff, L. S. (1977). The CES-D Scale: A Self-Report Depression
Scale for Research in the General Population. Applied Psychologi-
cal Measurement, 1(3), 385–401. https:// doi. org/ 10. 1177/ 01466
21677 00100 306
Raines, A. M., Currier, J., McManus, E. S., Walton, J. L., Uddo, M.,
& Franklin, C. L. (2017). Spiritual struggles and suicide in vet-
erans seeking PTSD treatment. Psychological Trauma: Theory,
Research, Practice and Policy, 9(6), 746–749. https:// doi. org/ 10.
1037/ tra00 00239
Reise, S. P. (2012). The Rediscovery of Bifactor Measurement Models.
Multivariate Behavioral Research, 47(5), 667–696. https:// doi.
org/ 10. 1080/ 00273 171. 2012. 715555
Reise, S. P., Scheines, R., Widaman, K. F., & Haviland, M. G. (2013).
Multidimensionality and Structural Coefficient Bias in Structural
Equation Modeling: A Bifactor Perspective. Educational and
Psychological Measurement, 73(1), 5–26. https:// doi. org/ 10. 1177/
00131 64412 449831
Rodriguez, A., Reise, S. P., & Haviland, M. G. (2016). Evaluating
bifactor models: Calculating and interpreting statistical indices.
Psychological Methods, 21(2), 137–150.
Rosmarin, D. H., Malloy, M. C., & Forester, B. P. (2014). Spiritual
Struggle and Affective Symptoms among Geriatric Mood Dis-
ordered Patients. International Journal of Geriatric Psychiatry,
29(6), 653–660. https:// doi. org/ 10. 1002/ gps. 4052
Saunders, S. M., Miller, M. L., & Bright, M. M. (2010). Spiritually
conscious psychological care. Professional Psychology: Research
and Practice, 41(5), 355–362. https://doi.org/10.1037/a0020953
Sedlar, A. E., Stauner, N., Pargament, K. I., Exline, J. J., Grubbs, J.
B., & Bradley, D. F. (2018). Spiritual Struggles among Atheists:
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Journal of Psychopathology and Behavioral Assessment (2025) 47:8 Page 15 of 15 8
Links to Psychological Distress and Well-Being. Religions, 9(8),
8. https:// doi. org/ 10. 3390/ rel90 80242
Spielberger, C. D. (1983). State-Trait Anxiety Inventory for
Adults(STAI-AD) [Database record]. APA PsycTests. https://
doi. org/ 10. 1037/ t06496- 000
Stauner, N., Exline, J., Grubbs, J., Pargament, K., Bradley, D., &
Uzdavines, A. (2016). Bifactor Models of Religious and Spiritual
Struggles: Distinct from Religiousness and Distress. Religions,
7(6), 68. https:// doi. org/ 10. 3390/ rel70 60068
Steger, M. F., Frazier, P., Oisha, S., & Kaler, M. (2006). The Meaning
in Life Questionnaire: Assessing the presence of and search for
meaning in life. Journal of Counseling Psychology, 53(1), 80–93.
Stucky, B. D., & Edelen, M. O. (2014). Using hierarchical IRT models
to create unidimensional measures from multidimensional data.
In S. P. Reise & D. A. Revicki (Eds.), Handbook of item response
theory modeling: Applications to typical performance assessment
(pp. 183–206). Routledge/Taylor & Francis Group.
VanderWeele, T. J. (2017a). Religious communities and human flour-
ishing. Current Directions in Psychological Science, 26, 476–481.
VanderWeele, T. J. (2017). On the promotion of human flourishing.
Proceedings of the National Academy of Sciences, 114(31), 8148–
8156. https:// doi. org/ 10. 1073/ pnas. 17029 96114
Wilt, J. A., Grubbs, J. B., Pargament, K. I., & Exline, J. J. (2017).
Religious and Spiritual Struggles, Past and Present: Relations to
the Big Five and Well-Being. The International Journal for the
Psychology of Religion, 27(1), 51–64. https:// doi. org/ 10. 1080/
10508 619. 2016. 11832 51
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