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   Table of Contents      
REVIEW ARTICLE
Year : 2018  |  Volume : 23  |  Issue : 6  |  Page : 411-420

The effect of listening to holy quran recitation on anxiety: A systematic review


1 Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
2 Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran

Date of Web Publication4-Oct-2018

Correspondence Address:
Ms. Ashraf Ghiasi
Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnmr.IJNMR_173_17

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  Abstract 


Background: Among all mental health disorders in the general population, anxiety is the most frequent. Both pharmacological and non-pharmacological interventions are used to manage anxiety in various settings. There is a growing interest among researchers on religion therapy as a non-pharmacological intervention for anxiety management. Hence, due to the importance of Holy Quran in Muslims' lives, this systematic review was performed to assess the studies that evaluated the effect of Quran recitation on anxiety in various settings. Materials and Methods: This systematic review study was performed on articles published between January 1990 and September 2017. Several online databases including SID, Iranmedex, Magiran, IranDoc, PubMed, Scopus, and Google Scholar were searched with the keywords of “Quran,” “anxiety,” “clinical trial.” The risk of bias across all included studies was assessed using the Cochrane Collaboration's risk of bias tool. Results: Of the 973 articles found in the initial search, 28 randomized controlled trials and quasi-experiments were selected for the systematic review. In most studies, State-Trait Anxiety Inventory was used to measure participants' anxiety. Findings of this review revealed a positive effect of listening to Holy Quran recitation in reducing anxiety in various settings. Only one study had reported that anxiety level in Holy Quran recitation group was less than that of the control group, but it was not statistically significant. Conclusions: Based on the available researches, Quran recitation can be used as a useful non-pharmacological treatment to reduce anxiety. However, methodologically strong randomized controlled trials are needed in this area.

Keywords: Anxiety, Holy Quran, Systematic review


How to cite this article:
Ghiasi A, Keramat A. The effect of listening to holy quran recitation on anxiety: A systematic review. Iranian J Nursing Midwifery Res 2018;23:411-20

How to cite this URL:
Ghiasi A, Keramat A. The effect of listening to holy quran recitation on anxiety: A systematic review. Iranian J Nursing Midwifery Res [serial online] 2018 [cited 2018 Dec 14];23:411-20. Available from: http://www.ijnmrjournal.net/text.asp?2018/23/6/411/242696




  Introduction Top


Among all mental health disorders in the general population, anxiety is the most frequent.[1] According to results from population-based surveys, approximately one third of the population is affected by an anxiety disorder during their lifetime.[2] Anxiety can be defined as a subjective feeling of tension, apprehension, nervousness, and worry accompanied by physiological arousal.[3] It is important to manage anxiety because it is systematically associated with negative outcomes such as quality of life (QOL) impairment, functional impairment, and lower productivity.[4] The Global Burden of Disease study 2010 (GBD 2010) estimated that anxiety disorders contributed to 26.8 million disability adjusted life years.[5] There are several pharmacological and non-pharmacological interventions for managing anxiety in various settings. Although pharmacological interventions such as selective serotonin reuptake inhibitors (SSRIs) have been traditionally used in the treatment of anxiety, some cannot use these drugs because of side-effects or interactions and others prefer not to use any medications.[3],[6] Recently, a range of non-pharmacological methods, such as aromatherapy, massage therapy, relaxation techniques, and music therapy, have been implemented to reduce anxiety.[7] The use of music as a therapeutic approach has an old history. Inscriptions in ancient Egypt, Greece, China, India, and Rome described music as a healing agent with a relaxing effect that reduces anxiety and creates relaxation.[8] The anxiolytic effects of music interventions on patients undergoing invasive procedures, cancer patients, and those suffering from Alzheimer's disease are confirmed in various studies.[[9],[10],[11] Although the use of music as a healing agent is not a new phenomenon, there has been scant research on religious music. The available studies indicate that religion and religious music may have a positive effect on mental health.[12] The Quran is the Holy book of Muslims; it covers all aspects of human life. Recitation of the Holy Quran is a form of mystical music that contributes to the release of endorphins by stimulating alpha brain waves.[13] Therefore, it enhances the stress threshold, removes negative emotions, and creates a sense of relaxation.[14] Hence, due to the importance of Holy Quran in Muslims' lives and the growing interest in non-pharmacological interventions by focusing on religion among researchers, this systematic review was performed to assess the studies that evaluated the effect of Quran recitation on anxiety in various settings.


  Materials and Methods Top


In this systematic review, national and international databases including SID, Iranmedex, Magiran, IranDoc, Scopus, and PubMed were searched in September 2017. Key words and MeSH terms such as “Quran,” “anxiety,” “clinical trial,” and Boolean operators “AND” and “OR” were used for searching in English databases. Persian terms equivalent to these English terms were used for searching in national electronic databases. To ensure that no relevant articles were missed, we also searched Google Scholar using both Persian and English search terms. All documents that were published between January 1990 and September 2017 were retrieved. Randomized controlled trials and quasi-experiments met the inclusion criteria if they assessed the effect of Quran recitation on anxiety. The studies conducted on healthy participants, patients with chronic diseases, or patients undergoing an invasive procedure were included. There was no age or gender restriction. If we could not retrieve the full text format of an article, we included its abstract only when it had sufficient information. Studies that were not published as full papers, such as conference abstracts were excluded. Two steps were taken to determine the eligibility of papers according to the inclusion criteria. First, the title and abstract of the identified papers were independently screened by two reviewers. Second, full texts were obtained for all potentially relevant articles. Disagreements were resolved by discussion between reviewers. The following information/data were extracted from studies that met the inclusion criteria: author(s) and year of publication, setting, sample size, participants, study methodology, outcome measures, and key findings.

The risk of bias in each included study was assessed using the Cochrane Collaboration's risk of bias tool.[15] The criteria consist of selection bias, performance bias, detection bias, attrition bias, and reporting bias. Each item was classified as “low risk of bias,” “high risk of bias,” or “unclear risk of bias.” Any discrepancy between the two reviewers were resolved by a discussion.

Ethical considerations

The study was approved by the Ethics Committee of Shahroud University of Medical Sciences with the ethical code IR.SHMU.REC.1396.150.


  Results Top


A total of 973 articles were retrieved on initial search query. After excluding 233 duplicates and 707 irrelevant articles, 33 studies remained for full-text evaluation. Of these, 5 were excluded because one of them did not assess the anxiety level and the others were abstract from conference. Finally, 28 studies (26 articles, 2 master's theses) were considered for systematic review. The flowchart used for retrieving the included articles is shown in [Figure 1].
Figure 1: PRISMA flow diagram

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Study characteristics

All the included studies were published between 1997 and 2017, and the total number of participants was 2,108, with a range of 24–180 per study. The study designs were a two-arm parallel group (n = 21),[16],[18],[19],[20],[21],[22],[23],[27],[28],[29],[30],[31],[32],[34],[35],[37],[38],[39],[40],[41],[42] a three-arm parallel group (n = 6),[17],[24],[25],[26],[33],[43] and a single-arm group (n = 1).[36] Fifteen studies assessed the effect of Quran recitation on anxiety in participants before an invasive procedure such as cesarean section,[16],[24],[28] induction of general anesthesia,[29],[33] open heart surgery,[22],[35] general surgery,[17],[19] cardiac catheterization,[34],[39] endoscopy,[26] lithotripsy,[21] hemodialysis,[42] and any invasive procedure.[32] In addition, five studies on student test anxiety,[27],[30],[31],[36],[37] two on athletes' anxiety,[20],[41] two on the anxiety of patients hospitalized in intensive care units,[18],[23] one on women's anxiety during pregnancy,[43] one on women's anxiety during first stage of labor,[38] one on nursing students' anxiety before entering the clinical practice,[25] and one study on prisoners' anxiety were conducted.[40]

Outcome measure

The State-Trait Anxiety Inventory (STAI) in 22 studies,[16],[17],[18],[19],[21],[22],[23],[24],[25],[26],[27],[29],[31],[32],[33],[34],[35],[36],[38],[39],[42],[43] the Test Anxiety Scale (TAS) in two studies,[30],[37] the Beck Anxiety Inventory (BAI) in two studies,[20],[40] the Competitive State Anxiety Inventory (CSAI) in one study,[41] and the Zung Self-Rating Anxiety Scale (SAS) in one study[28] were used to assess the level of anxiety in participants [Table 1].
Table 1: Characteristics of included studies

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Anxiety before exams in students

A study performed by Ghorbani et al. demonstrated that listening to the Quran recitation significantly reduced the anxiety level in the intervention group compared with the control group.[37] The research of Qasemtabar et al. confirmed the results of study by Ghorbani et al.[30] A study by Heidari and Shahbazi showed that anxiety level in nursing and emergency medicine students was significantly lower during exams with Quran recitation than the exams without it.[27] A study by Masoumy et al. on the medical students' test anxiety revealed that Quran recitation was significantly more effective than music sound.[31] Moreover, Ramazani et al., in a quasi-experimental study, stated that Quran recitation was effective in reducing pre-test anxiety level of medical sciences students.[36]

Anxiety in medical sciences students before entering the clinical practice

Findings of the study performed by Pour Dehkordi et al. indicated that both relaxation muscle therapy and listening to Holy Quran recitation along with reciting God's name were effective on reducing anxiety level of nursing students before entering the clinical practice.[25]

Anxiety in athletes

Mottaqhi, et al. in their study stated that Quran recitation significantly reduced anxiety level of female university athletes.[41] Another study by Aghamohamadi et al. showed that female university athletes who listened to Quran recitation had lower anxiety level than the control group but this difference was not statistically significant.[20]

Anxiety in prisoners

Akbari et al. assessed the effect of Quran recitation on prisoners' anxiety. They found that intervention group had significantly lower anxiety level than the control group.[37]

Anxiety during pregnancy

Study by Jabbari et al. on 168 pregnant women showed significant reduction in anxiety level of both intervention groups, one that listened to Quran recitation with translation and another that listened to Quran recitation without translation, when compared with the control group.[43]

Anxiety in first stage of labor

Sahmeddini et al. reported in their study that listening to the recitation of the Holy Quran during the active phase of labor had a positive effect in reducing anxiety.[38]

Anxiety in patients hospitalized in the intensive care units

Study conducted by Khatooni showed that listening to the recitation of the Holy Quran had a positive effect in reducing anxiety level of patients hospitalized in the cardiac care units.[23] A study performed by Najafi et al. showed that listening to Holy Quran recitation along with lavender aromatherapy was effective in reducing anxiety level of patients suffering from myocardial infarction.[18]

Anxiety before invasive procedures

In the study by Nikbakht Nasrabadi et al., it was found that listening to Holy Quran recitation had a positive effect on lowering the level of anxiety among patients hospitalized for invasive procedures.[32] Tajvidi et al. found that Holy Quran recitation was effective in reducing patients' anxiety before open heart surgery;[22] this had been confirmed by the research of Ildarabadi et al.[35] A study by Heidari and Shahbazi showed that listening to Quran was more effective in reducing anxiety before endoscopy procedure than listening to instrumental music.[26] Babaii et al. in their study found that Holy Quran recitation decreased patients' anxiety before cardiac catheterization.[39] Mirsane et al. demonstrated that listening to Quran recitation and its translation could reduce patients' anxiety before general surgery.[19] Atari et al. demonstrated that listening to Holy Quran recitation decreased the anxiety score of patients before anesthesia induction.[29] Another study by Shafiei et al. on patients' anxiety before induction of general anesthesia indicated that Holy Quran recitation with translation was significantly more effective than the same without translation.[33] Results of Majidi's study showed the positive effect of listening to Holy Quran in reducing anxiety level of patients hospitalized for angiography.[34] In another study, Babamohamadi et al. found that listening to Holy Quran recitation had a positive effect in reducing anxiety of patients undergoing hemodialysis.[42] Mirbagher Ajorpaz et al. found that both Quran recitation and instrumental music significantly reduced anxiety level of patients before abdominal surgery.[17] A study by Sharafi indicated that Holy Quran recitation compared with the Arabic music had a positive effect in lowering patient's anxiety before lithotripsy.[21] Sharifi et al. reported in their study that both Quran recitation and instrumental music reduced anxiety score of women before cesarean section. However, the recitation of Holy Quran was significantly more effective.[24] Allameh et al. indicated the positive effect of Quran recitation in reducing anxiety score of women undergoing cesarean section,[28] this had been confirmed by the research of Mirbagher Ajorpaz and Ranjbar.[16]

Risk of bias in included studies

Eight trials described randomization procedures, using random number table,[25],[37] block randomization,[18],[38],[43] throwing coins,[17],[42] or computer generation of random numbers.[28] The other trials did not describe the sequence randomization process. Only three trials were considered at low risk of bias for allocation concealment.[18],[38],[43] The other trials were rated “unclear,” as they did not have clear descriptions of their method of allocation concealment. All included studies failed to provide information about the blinding of participants, personnel and outcome assessors. All studies were judged to have a low risk of bias for incomplete outcome data; all studies had no participant losses, or the missing data were balanced in numbers across intervention groups. As far as we could see, all studies included were free of selective outcome reporting and other potential sources of bias. See [Figure 2]; “Risk of bias” graph and [Figure 3] “Risk of bias” summary of included studies.
Figure 2: Risk of bias' graph of included studies

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Figure 3: Risk of bias' summary of included studies

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  Discussion Top


This study aimed to systematically review studies that assessed the effect of listening to Holy Quran recitation on anxiety in various settings. Religion is an important socio-emotional resource and listening to religious music is an important part of religious life.[12] One of the most wonderful aspects of miraculous Quran is the sounds of reading Holy Quran's verses. Findings of our review revealed a positive effect of listening to Holy Quran recitation in reducing anxiety score in various settings. Only in one study that was conducted on female university athletes, anxiety level in experimental group was less than that of the control group but it was not statistically significant.[20] Relatively little research has addressed the relationships between listening to religious music and physiological processes. A study by Bradshaw et al. showed that listening to religious music among elderly people was associated with a decrease in death anxiety, and positively influenced in life satisfaction, self-esteem, and a sense of control over their lives.[12] During the past two decades, various studies have been carried out on therapeutic effect of Holy Quran recitation in Iran. Mahjoob et al. in their study found that Quran listening without its musical tone had a positive effect on the mental health of personnel in a medical sciences university.[44] The research by Shirvani et al. showed that listening to Holy Quran recitation stabilized vital signs and increased arterial oxygen pressure of unconscious patients in ICUs.[45] Keshavars et al. in their study aimed to assess the effect of Holy Quran recitation on physiological responses of premature infant found that pulse rate and respiratory rate significantly reduced in the intervention group compared to the control group.[46] Ansari Jaberi et al. found that listening to Holy Quran recitation had a positive effect in reducing depression.[47] Based on the results of this systematic review and other studies we can help people to decrease their anxiety by getting help from Holy Quran. Therefore, healthcare teams should consider Holy Quran recitation as an intervention, as this is an example of the holistic paradigm in health and the effects of such an intervention should be considered in a multidisciplinary and patient-centered approach. This highlights the need for education and training based on an ethical background that is very important when dealing with religiosity or spirituality.

This study has some limitations. We could not find any evidence assessing the effect of Holy Quran recitation on anxiety in other Islamic countries. Hence, this systematic review focused on studies that conducted in Iran. The low methodological quality and the high heterogeneity of the included studies mean that our findings must be interpreted with caution.


  Conclusion Top


The current evidence indicates that listening to Holy Quran recitation is a useful non-pharmacological treatment for reducing anxiety. However, due to the limited number of studies in this area, further research is needed to obtain more accurate evidence.

Acknowledgment

The authors would like to thank the Student Research Committee at Shahroud University of Medical Sciences.

Financial support and sponsorship

Student Research Committee at Shahroud University of Medical Sciences (Grant No 96184)

Conflicts of interest

Nothing to declare.



 
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