Spirituality is an ancient concept with many contemporary applications to the field of health promotion. While recognized in the UN Convention on the Rights of the Child as a basic human right, definitional misunderstandings about what spirituality is, and is not, and the mechanisms by which it affects the health of young people, remain. In this cross-national analysis involving >75 000 adolescents from 12 countries, we examined the relative importance of each of four spiritual health domains (connections to self, others, nature and the transcendent) in the lives of young people, and how these connections relate to a standard indicator of positive mental health status. Descriptive and applied regression analyses confirmed two major findings: (i) boys and girls in all 12 countries ranked the importance of each of the four domains in the same order, with ‘connections to self’ identified as most important; and (ii) both direct and indirect pathways are evident that connect the remaining three domains to positive mental health status, but through strong connections to self. Based on our scale items, fostering a strong connection to self, which involves cultivating a sense of meaning, purpose and joy in the lives of adolescents, appears most fundamental to fostering optimal mental health. This may be achieved directly or, dependent upon context and culture, indirectly with emphasis on the connections afforded by the other three domains. Such findings provide important insights to guide the content of adolescent health promotion interventions.

Spirituality is considered by many to be an important domain of health. It is sometimes measured in four domains of connections: to oneself, to others, to nature and to the transcendent. While the importance of such connections is recognized as a fundamental human right for children, few international studies have studied their impacts on the health and well-being of young people. In this study of young people conducted over 4 years in 12 countries, we examined the perceived importance of each of four spiritual health domains and how they each related to positive mental health status in >75 000 adolescents. ‘Connections to self’ were consistently viewed as most important among boys and girls in all 12 countries. Fostering of strong connections to self, which involves cultivating a sense of meaning, purpose and joy in the lives of adolescents, appears most fundamental to achieving mental health and well-being. This may be achieved directly through a focus on connections to self, or indirectly by focusing on the indirect effects of the other three domains on mental health. This opens up many opportunities for health promotion in child populations, internationally.

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