The findings of the current study found that there were average levels of religiosity, psychological immunity, and PWB among patients with diabetes in the Kingdom of Saudi Arabia. This result is not consistent with the results of the study conducted by Aldossari et al. (2022) which indicated a poorer level of PWB among diabetics in Saudi Arabia. Moreover, the study conducted by Debono & Cachia (2007) concluded that diabetes affected the level of PWB in patients. Diabetes is a chronic disease with an increasing prevalence rate all over the world. In Africa, the prevalence of diabetes will increase to 1 million people by 2025. Hence, diabetes is a health problem that harms the well-being and quality of patients, due to the multiple psychological and social stresses it causes, and negative emotional responses (Elgzyri, 2006; Onyishi et al., 2022).
Diabetics, because of the nature of their disease, are more susceptible to psychological problems. Lin et al. (2010) found a statistically significant correlation between negative psychological outcomes and diabetes. Moreover, previous studies (Katon et al., 2020, Deschênes et al., 2017, Alhunayni et al., 2020) indicated an association between depression and diabetes.
Furthermore, the results of the current study showed statistically significant differences between males and females with diabetes in religiosity, and the differences were in favor of females. This result is consistent with the findings of Miller and Hoffmann (1995) that females are more religious than males, and that preference for risk is a strong predictor of religiosity for both males and females. The possible reason to explain these differences in religiosity due to gender may be the socialization of females in Arab societies, which urges them to adhere to behavior. The woman turns to God a lot of the time of distress, and prays and blesses God. The nature of Arab women is religious and keen on a good relationship with God.
The results also revealed that there were statistically significant differences in psychological immunity, in favour of females. This is consistent with the results of studies (Al-Haraizah, 2020; Al-Rubai, 2020) that indicated differences between males and females in psychological immunity in favor of males. However, it differs from the results of Al-Saqa and Nadar’s study (2022) that indicated no differences in psychological immunity due to gender.
The results of the current study showed statistically significant differences in PWB in favor of females. This result is consistent with those of the studies (Al-Abri, 2023; Al-Audaini, 2018; Al- Jundi & Talhameh, 2017; Nabi et al., 2016) that indicated statistically significant differences in well-being in favor of females. However, it is not consistent with the results of studies (Yassin et al., 2014; Kharnoub, 2016) which did not find statistically significant differences in PWB due to the gender variable.
On the contrary, the results found no differences in religiosity, psychological immunity, and PWB due to the age group of patients with diabetes, and the reason may be that diabetes affects the individuals regardless of their age. This is consistent with the theoretical literature indications about the negative impact of diabetes on physical and psychological health (Alhunayni et al., 2020, Aldossari et al., 2022).
The possible reasons for PWB less represented in males than females may be the nature itself of males in Arab societies together with the large number of family, professional and social burdens they bear, as well as his diabetes and the accompanying physical symptoms that may make him fall short in performing roles expected of him, which imposes psychological pressure on him and negatively affects his mental health. Furthermore, the nature of males in Arab culture is that they believe that the expression of sadness and pain is weakness, so for the sake of their masculine strength he suppresses that within, which leads to a decrease in their well-being and quality of life as well as in his psychological immunity.
On the other hand, the results of the current study also revealed that religiosity was less predictive than psychological immunity of the PWB of diabetics, and this is consistent with the findings of Person et al (2004) indicating that religiosity is less predictive of healthy behavior.
The results of the current study indicated that psychological immunity was a strong predictor of PWB, and these results are consistent with the findings of the study (Amer, 2020) which concluded that psychological immunity predicts the quality of life. The Saffari et al. (2019) study showed that people with religious and spiritual beliefs are better aligned with their diagnosis of diabetes, more compliant with drug treatment, have positive mental health indicators and less anxiety and depression than others. Permana (2018) also showed that religious exercise can influence the management of diseases, including diabetes. Therefore, religiosity is an essential element in human existence all over the world (Sohil et al., 2020).
The result of the theoretical literature about the mental immune system confirmed that religiosity provides the individual with the ability to cope with stresses and deal with threats. In this way, psychological immunity helps to develop appropriate behavior and enhance adaptation to changing conditions, while the reinforcement mechanisms involved in psychological immunity help to enhance PWB (Choochom et al., 2019; Oláh, 2005; Pasichnyk et al., 2017; Koenig, 2000).
Oláh's model (2005) of the mental immune system describes an integrated structure of 16 reinforcing and protective personal competencies that help manage environmental stressors. This model operates as a super-system consisting of three sub-systems in continuous interactions. These sub-systems are the Approach-Belief, the control-creation-executive sub-system, and the self-regulation sub-system. The first, the Belief-Approach Subsystem, is supposed to help people adjust to their environment. This subsystem contains several procedural factors: optimism, a sense of coherence, a sense of development, control capacity, personal ability to monitor the source, and the ability to monitor the social resource (Bredács, 2016). Optimism involves the belief that current events are heading toward ideal situations. The sense of coherence involves harmony between thoughts, emotions, behavior, and lifestyle. The sense of development involves an ongoing experience of self-development and achievement. Control capacity refers to the ability to control emotions. The ability to monitor the social resource refers to the sensitive ability to selectively observe and use social and environmental cues and information. The ABS belief system focuses on approach orientation, fostering expectations of positive outcomes, a belief in the manageability and the manageability of the environment, and a drive for self-actualization (Voitkāne, 2004).
The second subsystem of Oláh's model (2005) is the Control, Creativity, and Execution Subsystem. The five components of this system help stimulate the exploration of physical, social, and personal phenomena to find new challenges and experiences. It includes the ability to mobilize a personal resource, the ability to create a personal resource, the ability to mobilize a social resource and a social resource that creates capacity, and self-esteem. The ability to mobilize personal resources includes mechanisms for strengthening faith, achieving goals, and choosing appropriate behavior (Bredács, 2016). The creation of interpersonal capacity refers to the degree of creativity or innovation of an individual in developing, managing, and restructuring life plans and information based on personal perception. The social resource mobilization capacity includes the individual's ability to make connections, acquire social capital, and gain acceptance and approval from all. The ability to create a social resource includes the mechanisms that help build and organize teams and collaborate. Finally, self-esteem involves the degree of positive and realistic self-esteem, self-esteem, and moderation when it comes to pride. In addition to achieving factors such as creative self-concept and social mobilization capacity, components of the executive subsystem include the creative capacity to generate new ideas and alternative possibilities, all of which are important for personal and social adjustment.
The third subsystem in Oláh's model (2005) is the Self-Regulatory Subsystem (SRS), which stabilizes I-belief and subsystem II-executive by managing vulnerable feelings and thoughts that interfere with planned behavior. The five components of this system include impulse control, excitability control, impulse control, persistence, and the ability to synchronize. Impulse control means an individual's ability to transform negative emotions constructively. The ability to control arousal includes the ability to control anger and apply it constructively. Impulse control includes the ability to control personal perceptions, rationalize positive behavior, and choose appropriate behavior within context. Perseverance indicates the ability to accomplish tasks despite being inhibited by obstacles. The individual also has a high tolerance for frustration. The ability to synchronize includes the ability to perceive environmental changes while attending to interpersonal activities (Bredács, 2016; Choochom, 2014, Shastri, 2013).
According to Oláh (2000) view, it can be concluded that psychological immunity is a multidimensional construct that provides resistance to psychological trauma and stress, and increases the PWB among diabetes patients.
Limitations and Future Directions:
The comparative predictive cross-sectional design was used in the current study, which was not a follow-up, to examine the effect of diabetes on the level of PWB, mental immunity, and religiosity over time and at different periods. In this study, we did not examine the effect of demographic variables in predicting PWB in patients with diabetes. The current study was not an interventional study that examined the effect of psychological interventions based on religiosity and psychological immunity to increase PWB among diabetes patients. Further studies are needed and recommended in the future focusing on these important aspects of the PWB of patients with diabetes.