Spiritual well-being and mental health among medical students in Riyadh: a cross-sectional study differentiating religious and existential dimensions

Medical students face disproportionately high rates of depression and anxiety, yet the protective role of spirituality remains poorly understood, particularly regarding distinct contributions of religious versus existential well-being. This study examined how spiritual well-being — decomposed into Religious Well-Being (RWB) and Existential Well-Being (EWB) — relates to both outcomes among Saudi medical students, addressing a gap in Muslim-majority contexts where dimensional analysis has rarely been conducted. A cross-sectional, web-based survey recruited 400 undergraduate medical students from Riyadh (January–April 2026). Validated Arabic instruments assessed depression (PHQ-9), anxiety (GAD-7), and spiritual well-being (SWBS). Hierarchical regression examined independent contributions of RWB and EWB after controlling for demographics. Using a PHQ-9 cutoff ≥ 10, 33.75% screened positive for clinically significant depressive symptoms and 32.50% screened positive for clinically significant anxiety symptoms EWB was the sole significant predictor of depression (β = −0.543, p < .001) and anxiety (β = −0.353, p < .001); RWB was not independently significant for either outcome. Final models explained 27.7% of variance in depression and 27.8% in anxiety. Female sex independently predicted higher anxiety (β = 0.359, p < .001), and clinical-year students had significantly higher anxiety and lower spiritual well-being than preclinical peers. Existential well-being — encompassing meaning, purpose, and life satisfaction — showed stronger independent associations with lower depressive and anxiety symptom scores than religious well-being in this Muslim medical student cohort, while religious well-being, though uniformly high, was not independently associated with either outcome. These findings are associative and cannot establish causation; however, they suggest that meaning-centered approaches may be particularly relevant for mental health promotion in this population.