Iran Journal of Nursing

Introduction
Children with autism have numerous behavioral problems, including stereotypes, self-stimulation, interaction problems, and aggression. Such behaviors create problems in the upbringing of patients with autism and cause a lot of stress to parents, especially mothers. Mothers of children with autism face many problems that can affect their life. On the other hand, spirituality, as one of the essential aspects of human existence, has a significant relationship with human health. Today, spirituality as a dimension of humanity and its role in the recovery of people is increasingly considered since it is known as a basic concept to meet the psychological needs of people. 
Spirituality is one of the existential dimensions of humanity that creates meaning in life and inspires one to face problems. Spirituality, as one of the critical aspects of human existence, has an important relationship with people’s health. It can be said that without spiritual health, other biological, mental and social dimensions cannot function properly or reach their maximum capacity. Spiritual well-being is one of the critical dimensions of human health that provides a harmonious and integrated connection between the forces within man and leads to stability in life, peace, and harmony, and a sense of close contact with oneself, God, society, and the environment. 
Spiritual well-being determines the integrity of the individual and plays a significant role in individuals’ mental and physical health. People with spiritual well-being have more power of control and social support. Spiritual well-being plays a role in countering despair and, in a way, gives meaning and motivation to the stressful and sad life of the person and those around him. Spiritual well-being may be able to overcome some of the physical problems of individuals. Spiritual well-being is associated with psychological well-being and quality of life. Having a sense of life satisfaction, effective interaction with the world, and progress are characteristics of a person with spiritual health. Spiritual well-being plays a role in relieving mothers’ stress and frustration. Spiritual well-being for mothers of mentally retarded children creates a positive outlook on life with hope and meaning in their lives and encourages them to endure hardships. This study seeks to determine the spiritual well-being of mothers of children with autism.

Material and Methods
The type of present study was descriptive-cross-sectional. In this study, mothers were identified out of 7 schools for children with autism, and 200 people participated in the survey in stages, according to the following inclusion criteria: being literate, having a child with autism in the age range of 6-11 years, not having a disease other than autism for the child, not having a new acute and stressful problem for the mother during the last 2 months, such as the death of loved ones and not having a known physical and mental problem for the mother. 
After approval of the ethics committee of the ethics committee of the researcher university by referring to the educational organization and obtaining the necessary permits and arrangements made to special schools for children with autism and in coordination with school officials after obtaining the consent of mothers and gaining trust, in the form of demographic characteristics, the variables of age, occupation, level of education, economic status, number of children and age of a child with autism were measured. 
Due to the current situation in the community (dealing with the COVID-19 pandemic), there was no direct access to mothers, and data collection was done indirectly by involving mothers in virtual groups and on the WhatsApp social network. The approximate time of data collection was generally estimated to be 6 months. 
Along with obtaining written consent from the samples, they were told that the information contained in the instrument without mentioning the name and confidentiality would remain, and there will be no obligation to participate in the research. The collected data were used using descriptive statistical methods such as setting frequency distribution tables, calculating numerical indices, and independent chi-square and t-test. The paired t-test was used to achieve the goals under SPSS software v. 16.

Results
The Mean±SD spiritual well-being of mothers was 77.17±10.51. Mean±SD spiritual well-being (41.11±5.61) had the highest, and existential well-being (36.06±5.67) had the lowest score. In terms of spiritual well-being, the words “I believe that God loves me and cares for me” had the highest score with an average of 4.64, and the terms “I do not receive much strength and support from God” had the lowest score with an average of 2.88. Regarding existential well-being, the item “I do not enjoy my life much” with an average of 4.43 had the highest score, and the item “I have reached perfection in life, and I am satisfied with life” with an average of 2.7 had the lowest score.

Discussion
In this study, the spiritual well-being dimension of spiritual well-being was in a better position compared to its Existential Dimension of Health. The mothers participating in the present study are more prosperous in spiritual well-being than existential health. In other words, living with a child with a mental disability or a chronic illness such as autism puts their mothers’ existential health at greater risk than their spiritual well-being compared to their spiritual health. 
In the cultural context of Iran, since individuals have a rich religious background, this has led to a higher spiritual well-being score for mothers of children with autism compared to their existential health. At the same time, to promote the Existential Dimension of Health of this group of mothers, it is necessary to implement interventions based on spiritual education for them. 
In the current study, there was no statistically significant relationship between any demographic characteristics of mothers with autistic children and their spiritual health. At the same time, considering the role these characteristics may play in spiritual health, it is recommended that more studies be done to achieve more profound results.

Ethical Considerations

Compliance with ethical guidelines
The Ethical Committee approved this study of the Iran University of Medical Sciences (Code: IR.IUMS. REC.1399.798). All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information. They were free to leave the study whenever they wished, and the research results would be available if they desired.

Funding
This study is extracted from the MA thesis of the first author at the Department of Psychiatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran.

Authors' contributions
Conceptualization: Fatemeh Soltani and Marjan Mardani Hamouleh; Research: Marjan Mardani Hamouleh, Naimeh Seyed Fatemi and Hadi Hamidi; Data Analysis: Shima Haqqani.

Conflict of interest
The authors declared no conflict of interest.
 

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