Coping as a Pathway Linking Religiosity and Spirituality to Mental Health and Early Cardio-Cerebrovascular Risk Among University Students in Malaysia

Background: Mental health disorders such as depression, anxiety, and stress are increasingly prevalent among university students and contribute to long-term cardio-cerebrovascular disease (CCVD) risk. However, limited research has examined the interplay between mental health, CCVD risk factors, and religiosity/spirituality within Southeast Asia’s multicultural context. Methods: This cross-sectional study investigated these relationships among 484 undergraduate students enrolled in medical and health sciences programs across Peninsular Malaysia. Mental health status was assessed using the Depression, Anxiety, and Stress Scale (DASS-21). Self-reported clinical indicators associated with early CCVD vulnerability were also assessed. Religiosity and spirituality were measured using the Duke University Religion Index (DUREL), Brief Religious Coping (RCOPE), Spirituality Scale (SS), and Spiritual Coping Questionnaire (SCQ). Results: High prevalence rates of severe anxiety (50.4%), depression (29.3%), and stress (21.1%) were observed, with significant associations across ethnicity, religion, and academic programs. Higher religiosity and spirituality were generally associated with better mental health outcomes. However, coping style emerged as a key modifier of the relationship between religiosity/spirituality and mental health outcomes, with negative religious coping associated with greater psychological distress, whereas positive coping demonstrated mixed associations and partial mediating effects. Students with poorer mental health also exhibited higher CCVD risk burden. Conclusions: These findings highlight the importance of culturally and spiritually sensitive strategies in promoting student well-being.