Underlying spirituality and mental health: the role of burnout.

Dear editor,

This is in reference to the article "Underlying spirituality and mental health: the role of burnout" published in J Occup Health 2016; 58: 66-71 by Ho RT et al[1)].

First of all, I would like to appreciate the efforts of the authors because this article brings back the attention of the medical personnel toward mental health and spirituality. These concepts are not only difficult to define but also difficult to measure, analyze, and interpret. The studies done in the field require strong methodology and interpretation to understand the need for spiritual and mental well-being in today's world.

However, in this cross-sectional study, there are a few issues that do not seem appropriate and are confusing to the readership. The study only included health care workers; however, this does not reflect in the title, which leads to confusion and issues related to the generalization of this study to the entire population. Furthermore, the rationale of the study was not mentioned. The methodology was not very clear. The logic of arriving at the sample size of 350 was not justified. They have commented on having chosen a Chinese sample in the discussion, which creates confusion regarding the intention of specifically choosing a Chinese sample for this study. This study could have also elaborated the term "mediation". The scales used in the study were reliable and valid as acknowledged, but the reason why they were considered over other standard scales was not mentioned. The Daily Spiritual Experience Scale (DSES) was used in this study to quantify the daily spiritual experience (independent variable in the study). The results were interpreted as higher scores in the DSES scale indicated higher spiritual experience. But lower scores reflect a more frequent spiritual experience as per Underwood[2)]. Although statistical analysis seems adequate, the need for the use of standardized beta coefficient could have been justified. It would have been more appropriate if traditional stratified analyses, i.e., multivariable regression analysis could have been applied to find association. The purpose of table 2 in the study results was not understood. The R2 change that was mentioned in the results was not complete. Change with respect to which variable is missing and the change mentioned in the study did not give information if it was in absolute or relative figures.

We require many more studies with appropriate methodology to address these issues. These issues also play a major role in sustainable developmental goals, and successful efforts to tackle these issues can help us in moving toward achieving the goals and a better living environment.

Conflicts of interest: The authors declare that there are no conflicts of interest.